High Systolic Blood Pressure, Anterior Segment Changes and Visual Impairment Independently Predict Sickle Cell Retinopathy

Sickle cell disease is often complicated by retinopathy, which can be proliferative or non proliferative. Proliferative sickle cell retinopathy potentially leads to blindness. There is a paucity of data on sickle cell disease-related retinopathy from Africa, where the disease is most prevalent. We aimed to determine the clinical, ophthalmic, and laboratory predictors of sickle cell retinopathy in an African population. We conducted a cross-sectional study of 262 participants, aged 13 years and above, with sickle cell disease. Demographic and clinical data were collected using a structured questionnaire and standard physical examinations. Vitreo-retinal specialists performed eye examinations on all the participants. Hematological and biochemical assessments were conducted using standard methods. A multivariate stepwise forward logistic regression was performed to determine the predictors of retinopathy. The median age of the participants was 20 years (interquartile range: 17–25 years). Most of the participants had a homozygous Hb S (<i>HBB</i>: c.20A&gt;T) genotype (96.9%), with 3.1% who carried a Hb S/Hb C (<i>HBB</i>: c.19G&gt;A) genotype. The prevalence of non proliferative sickle cell retinopathy was 24.4%. Only 1.9% had proliferative sickle cell retinopathy (PSCR). Elevated systolic blood pressure (BP) [odds ratio (OR): 6.85, 95% confidence interval (95% CI): 1.05–44.45, <i>p</i> = 0.059], moderate visual impairment (OR: 5.2, 95% CI: 1.39–19.63, <i>p</i> = 0.015), and anterior segment changes (OR: 2.21, 95% CI: 1.19–4.13, <i>p</i> = 0.012) were independently predictive of retinopathy. This study provides new insight into predictors of retinopathy in sickle cell disease, with implications on early screening and prevention.

镰状细胞病（sickle cell disease）常并发视网膜病变，可分为增生性与非增生性两类。增生性镰状细胞视网膜病变可能引发失明。在该病流行程度最高的非洲地区，关于镰状细胞病相关视网膜病变的研究数据仍较为匮乏。本研究旨在明确非洲人群中镰状细胞视网膜病变的临床、眼科及实验室预测因素。
我们纳入262名13岁及以上的镰状细胞病患者开展横断面研究。通过结构化问卷与标准体格检查收集人口学与临床资料。所有受试者均接受玻璃体视网膜专科医师的眼部检查。采用标准方法进行血液学与生化检测。运用多因素逐步向前逻辑回归分析筛选视网膜病变的预测因素。
受试者的中位年龄为20岁（四分位间距：17~25岁）。多数受试者为纯合子Hb S（<i>HBB</i>: c.20A&gt;T）基因型（96.9%），仅3.1%携带Hb S/Hb C（<i>HBB</i>: c.19G&gt;A）基因型。非增生性镰状细胞视网膜病变的患病率为24.4%，仅1.9%的受试者患有增生性镰状细胞视网膜病变（PSCR）。
收缩压升高[比值比（OR）=6.85，95%置信区间（95%CI）：1.05~44.45，<i>p</i>=0.059]、中度视力损害（OR=5.2，95%CI：1.39~19.63，<i>p</i>=0.015）以及眼前节改变（OR=2.21，95%CI：1.19~4.13，<i>p</i>=0.012）是视网膜病变的独立预测因素。
本研究为镰状细胞病相关视网膜病变的预测因素提供了新的认识，对早期筛查与预防工作具有指导意义。