Anterior segment ischemia following scleral buckling in sickle cell hemoglobinopathy

Ten eyes of nine sickle cell-hemoglobin C patients (SC) underwent retinal detachment surgery. Six eyes showed signs of anterior segment ischemia postoperatively, and one showed signs of retinal ischemia. Four eyes became phthisical or prephthisical. In three cases, anterior segment ischemia was erroneously thought to be infectious endophthalmitis. In a sampled hospital population, 71% of buckled eyes of SC patients developed anterior segment ischemia, whereas only 3% of nonsickling eyes developed this postoperative complication during the same five-year period. Patients with SC hemoglobin thus appear particularly vulnerable to anterior segment ischemia following scleral buckling. Lower hematocrit, younger age, and female sex were associated with clinically less severe postoperative findings. Technical surgical factors did not seem to influence the presence or absence of postoperative anterior segment ischemia. Partial exchange blood transfusion and additional measures were employed in three cases. When the patients' hemoglobin A was increased to more than 60%, anterior segment ischemia did not develop despite extensive, prolonged scleral buckling operations.