What is the role of ocular surgery in the treatment of sickle cell disease (SCD)?

Updated: Jul 22, 2021
  • Author: Mark Ventocilla, OD, FAAO; Chief Editor: Andrew G Lee, MD  more...
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Surgical procedures may be performed to treat retinal detachments, nonclearing vitreous hemorrhage, and epiretinal membranes. Based on a 71% incidence of anterior segment ischemia in patients with PSR who are undergoing scleral buckling surgery, prophylactic preoperative exchange transfusions or erythropheresis is recommended. Risks associated with exchange transfusions and improvement in vitreoretinal surgical techniques warrant a careful reevaluation of prophylactic exchange transfusions.

Perioperative measures to reduce the incidence of anterior segment ischemia include the following:

  • Nonsympathomimetic local anesthesia

  • Minimization of topical sympathomimetics

  • Supplemental oxygen for 48 hours after surgery

  • Avoiding wide encircling scleral buckling elements, expansile concentrations of intraocular gases, and carbonic anhydrase inhibitors

  • Closely monitoring and treating elevated intraocular pressure

Anterior segment ischemia after surgery is an emergency. Although the prognosis is notoriously poor, make all attempts to oxygenate the anterior segment. Options include hyperbaric oxygen therapy, continuous supplemental oxygen therapy, and transcorneal oxygen with goggles. [11]

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