Surgery for Sickle Cell Retinopathy

This chapter discusses the indications, surgical considerations, and techniques for managing proliferative sickle cell-related vitreoretinal complications including vitreous hemorrhage, tractional retinal detachment (TRD), epiretinal membranes, and macular holes. Preoperative optimization of the patient’s systemic condition is crucial, and considerations for anesthesia, hemoglobin levels, and coagulation factors are discussed. Surgical procedures involve careful posterior hyaloid induction, which is usually adherent, membrane dissection, endolaser, and the use of tamponade if needed. The authors favor conservative membrane segmentation in sickle cell retinopathy TRD rather than attempting extensive delamination. The outcomes of surgical interventions vary based on the severity of vitreoretinal pathology, with best results observed in uncomplicated vitreous hemorrhages. Caution is advised in surgery for sickle cell TRD as iatrogenic retinal breaks with unrelieved vitreous traction and retinectomies result in poor anatomical and visual outcomes.