What is the role of vitrectomy in the treatment of hemoglobinopathy retinopathy?

Updated: Sep 03, 2019
  • Author: Brian A Phillpotts, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Indicated in cases of nonresolving vitreous hemorrhage and retinal detachment (stages IV and V).

One of the more serious complications that is associated with vitreoretinal surgery is anterior segment ischemia. Other complications include sickling crisis, optic nerve, and macula infarctions.

This procedure relieves the internal tractional forces that act on the retina and facilitate retinal photocoagulation.

Rhegmatogenous retinal detachment in sickle cell disease usually is secondary to tractional membrane. Usually requiring pars plana vitrectomy, it seldom is treated with scleral buckling alone.

The following measures can decrease complications (ie, anterior segment ischemia):

  • Preoperative partial exchange transfusions (rarely required) increase the amount of normal hemoglobin Hb A, thereby increasing the O2 -carrying capacity

  • Administer local anesthesia, stellate ganglion block, and papaverine administration

  • Provide cycloplegics (parasympathomimetics only)

  • Decrease IOP

  • Provide supplemental oxygen therapy

  • IOP should be kept lower than 25 mm Hg preoperatively, intraoperatively, and postoperatively


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