Laser therapy for retinopathy in sickle cell disease

Abstract

Our conclusions are based on the data from two trials conducted over 20 years ago. In the absence of further evidence, laser treatment for sickle cell disease-related retinopathy should be considered as a one of therapeutic options for preventing visual loss and vitreous haemorrhage. However, it does not appear to have a significant different effect on other clinical outcomes such as regression of proliferative sickle retinopathy and development of new ones. No evidence is available assessing efficacy in relation to patient-important outcomes (such as quality of life or the loss of a driving licence). There is limited evidence on safety, overall, scatter argon laser photocoagulation is superior in terms of adverse effects, although feeder vessel coagulation has a better effect in preventing vitreous haemorrhage. Further research is needed to examine the safety of laser treatment compared to other interventions such as intravitreal injection of anti-vascular endothelial growth factors. In addition, patient-important outcomes as well as cost-effectiveness should be addressed.

New Ways to Detect Pediatric Sickle Cell Retinopathy: A Comprehensive Review

“…It is effective in reducing the incidence of loss of visual acuity as well as the incidence of vitreous hemorrhage. [64, 70, 71] One study of 21 eyes with PSR found complete regression in 24 of 28 sea fan lesions treated with scatter laser photocoagulation. [72] Others have found complete regression in 30.2% of treated eyes compared to 22.4% of untreated control eyes.…”

Expression Pattern of HIF-1α and VEGF Supports Circumferential Application of Scatter Laser for Proliferative Sickle Retinopathy

“…25 There have been three principal approaches for the use of LPC in PSR treatment: (1) specifically targeting feeder vessels of neovascular sea fans (now, largely abandoned); (2) sectoral laser to treat the (presumably) ischemic retina immediately surrounding the neovascular sea fan; or (3) circumferential laser to treat all of the ischemic retina, whether affected or not affected by sea fans (largely reserved for patients who are at risk for not returning for follow-up care). 10 The use of sectoral or circumferential scatter LPC in PSR patients may be supported by extrapolation from extensive studies demonstrating the successful use of panretinal laser photocoagulation (PRP) for the treatment of PDR in diabetic patients; clinical trials have demonstrated the clear benefit of PRP for high-risk PDR. 11 However, an equivalent benefit of scatter LPC has not yet been unequivocally demonstrated for patients with PSR.…”

“…11 However, an equivalent benefit of scatter LPC has not yet been unequivocally demonstrated for patients with PSR. 10 …”

“…10 Laser photocoagulation has been successfully used for the treatment of other ischemic retinopathies, most notably proliferative diabetic retinopathy (PDR), 11 but also for retinopathy of prematurity (ROP) and retinal vein occlusions. However, clinical trials have failed to demonstrate a clear benefit of LPC for patients with PSR, 10 raising questions as to whether current treatment approaches result in better outcomes than observation alone.…”

“…Indeed, a recent review published in the Cochrane Database of Systematic Reviews reports that there are only two randomized controlled clinical trials that compare LPC to no treatment in patients with PSR, 12,13 and both have failed to clearly demonstrate its efficacy for PSR patients. 10 …”