Anti-Vascular Endothelial Growth Factor Therapy for Stages 3 and 4 Proliferative Sickle Cell Retinopathy Results in Improved Anatomic and Visual Outcomes

Purpose:To investigate the potential utility of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for stages 3 and 4 proliferative sickle cell retinopathy (PSR).Methods:Retrospective review of anatomic and visual acuity outcomes after intravitreal anti-VEGF therapy for stages 3 and 4 PSR eyes.Results:There were 45 PSR eyes (17 stage 3 and 28 stage 4) treated with anti-VEGF agents (bevacizumab (37 eyes), aflibercept (6 eyes), ranibizumab (3 eyes), one eye received 2 both bevacizumab and aflibercept). Follow-up ranged from 1 to 120 months (mean= 21 months). Within 1 month after anti-VEGF treatment, VA improved > 2 lines in 17/45 eyes, remained stable in 27/45 eyes and worsened in 1/45 eyes. Median visual acuity remained 20/20 for stage 3 and improved from 20/200 to 20/30 for stage 4 PSR eyes. More stage 4 PSR eyes had VA improvement post-treatment than stage 3 PSR eyes (P=0.003). There were no cases of endophthalmitis. Visual acuity outcomes were similar for anti-VEGF with and without laser treatment. Control of PSR was achieved in 42/45 (93%) of eyes without the need for pars plana vitrectomy.Conclusion:Within one month of treatment, administration of anti-VEGF therapy of PSR eyes resulted in seafan regression, clearing of vitreous hemorrhage, and stable or improved vision in most eyes.