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Erythropheresis in Treating Retinal Detachments Secondary to Sickle-Cell Retinopathy
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AMERICAN JOURNAL OF OPHTHALMOLOGY
plasm was not only confined to the cor nea, but also grew deep into corneal tissue all the way to Descemet's mem brane, which is very uncommon. Limbal tumors usually grow over the cornea without penetrating into the stroma. REFERENCES 1. Pfaffenbach, H. D., and Green, W. R.: Ectopic lacrimal gland. Int. Ophthalmol. Clin. 3:149, 1971. 2. Friedenwald, J.: Ophthalmic Pathology. Phila delphia, W. R. Saunders Co., 1952, p. 409. 3. Duke-Elder, S., and Leigh, A. C : Diseases of the Outer Eye. Cornea and Sciera. In Duke-Elder, S. (ed.): System of Ophthalmology, vol. 8, pt. 2. St. Louis, C. V. Mosby, 1965, p. 1175.
E R Y T H R O P H E R E S I S IN TREATING RETINAL D E T A C H M E N T S SECONDARY T O S I C K L E - C E L L RETINOPATHY J O S E P H L. W I L H E L M , M.D., Z. N I C H O L A S ZAKOV, M.D., AND G E R A L D A. H O E L T G E , M.D.
Cleveland, Ohio
We used erythropheresis in stead of partial exchange transfu sion to increase the levels of hemoglobin A in patients with sickle-cell disease. The process takes only 90 minutes and reduces the preoperative hospitalization period substantially. Proliferative retinopathy of sickle-cell disease can cause retinal detachments
From the Department of Ophthalmology (Dr. Wil helm and Dr. Zakov) and the Rlood Rank (Dr. Hoeltge), Cleveland Clinic, Cleveland, Ohio. Reprint requests to Z. Nicholas Zakov, M.D., Department of Ophthalmology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44106.
OCTOBER, 1981
and vitreous hemorrhages. 1 Unfortunate ly, surgery for these complications can cause anterior segment ischemia and loss of the eye. Ryan and Goldberg 2 recom mended several prophylactic measures to decrease the incidence of anterior seg ment ischemia in these cases. Among their recommendations was a partial ex change transfusion to increase the level of hemoglobin A. This process requires sev eral days of hospitalization for comple tion. We have begun using a new method, erythropheresis, for changing the levels of hemoglobin A in this type of patient. This technique has been used on patients with sickle-cell disease who are pregnant or who are about to undergo general surgery. 3 ' 4 A model 2997 IBM blood cell separator is used. The patient is given the appropriate heparin dose in a single in travenous push, and blood is pumped from an antecubital vein through an 18-g angiocatheter with side holes. The red blood cell pump speed is set at 25 ml/min, and the white blood cell pump speed is set at 20 ml/min. The plasma pump speed is set at 35 ml/min. The centrifuge speed is 1,100 rpm. Approxi mately 1,800 ml of fluid from the red blood cell line is removed and replaced with approximately 1,500 ml of washed leukocyte-poor packed cells. The exact amounts depend upon the patient's hemoglobin A levels. The entire process takes about 90 minutes. We believe that we achieve the same results with erythropheresis as with a partial exchange transfusion but that there is significant decrease in the length of preoperative hospitalization. There fore, we recommend and have used eryth ropheresis not only for the repair of rhegmatogenous retinal detachment with sickling retinopathy, but also for patients undergoing pars plana vitrectomy who may require scierai buckling.
VOL. 92, NO. 4
NOTES, CASES, INSTRUMENTS
REFERENCES 1. Goldberg, M. F. : Classification and pathogenesis of proliferative sickle retinopathy. Am. J. Oph thalmol. 71:649, 1971. 2. Ryan, S. J., and Goldberg, M. F.: Anterior segment ischemia following scierai buckling in sickle cell hemoglobinopathy. Am. J. Ophthalmol. 72:35, 1971.
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3. Kernoff, M., Botha, M., and Jacobs, P.: Ex change transfusion in sickle cell disease using a continuous-flow blood separator. Transfusion 17:269, 1977. 4. Key, T., Horger, E., Walker, E., and Mitchum, E.: Automated erythrocytopheresis for sickle cell anemia during pregnancy. Am. J. Obstet. Gynecol. 7:731, 1980.
AMERICAN JOURNAL OF OPHTHALMOLOGY
plasm was not only confined to the cor nea, but also grew deep into corneal tissue all the way to Descemet's mem brane, which is very uncommon. Limbal tumors usually grow over the cornea without penetrating into the stroma. REFERENCES 1. Pfaffenbach, H. D., and Green, W. R.: Ectopic lacrimal gland. Int. Ophthalmol. Clin. 3:149, 1971. 2. Friedenwald, J.: Ophthalmic Pathology. Phila delphia, W. R. Saunders Co., 1952, p. 409. 3. Duke-Elder, S., and Leigh, A. C : Diseases of the Outer Eye. Cornea and Sciera. In Duke-Elder, S. (ed.): System of Ophthalmology, vol. 8, pt. 2. St. Louis, C. V. Mosby, 1965, p. 1175.
E R Y T H R O P H E R E S I S IN TREATING RETINAL D E T A C H M E N T S SECONDARY T O S I C K L E - C E L L RETINOPATHY J O S E P H L. W I L H E L M , M.D., Z. N I C H O L A S ZAKOV, M.D., AND G E R A L D A. H O E L T G E , M.D.
Cleveland, Ohio
We used erythropheresis in stead of partial exchange transfu sion to increase the levels of hemoglobin A in patients with sickle-cell disease. The process takes only 90 minutes and reduces the preoperative hospitalization period substantially. Proliferative retinopathy of sickle-cell disease can cause retinal detachments
From the Department of Ophthalmology (Dr. Wil helm and Dr. Zakov) and the Rlood Rank (Dr. Hoeltge), Cleveland Clinic, Cleveland, Ohio. Reprint requests to Z. Nicholas Zakov, M.D., Department of Ophthalmology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44106.
OCTOBER, 1981
and vitreous hemorrhages. 1 Unfortunate ly, surgery for these complications can cause anterior segment ischemia and loss of the eye. Ryan and Goldberg 2 recom mended several prophylactic measures to decrease the incidence of anterior seg ment ischemia in these cases. Among their recommendations was a partial ex change transfusion to increase the level of hemoglobin A. This process requires sev eral days of hospitalization for comple tion. We have begun using a new method, erythropheresis, for changing the levels of hemoglobin A in this type of patient. This technique has been used on patients with sickle-cell disease who are pregnant or who are about to undergo general surgery. 3 ' 4 A model 2997 IBM blood cell separator is used. The patient is given the appropriate heparin dose in a single in travenous push, and blood is pumped from an antecubital vein through an 18-g angiocatheter with side holes. The red blood cell pump speed is set at 25 ml/min, and the white blood cell pump speed is set at 20 ml/min. The plasma pump speed is set at 35 ml/min. The centrifuge speed is 1,100 rpm. Approxi mately 1,800 ml of fluid from the red blood cell line is removed and replaced with approximately 1,500 ml of washed leukocyte-poor packed cells. The exact amounts depend upon the patient's hemoglobin A levels. The entire process takes about 90 minutes. We believe that we achieve the same results with erythropheresis as with a partial exchange transfusion but that there is significant decrease in the length of preoperative hospitalization. There fore, we recommend and have used eryth ropheresis not only for the repair of rhegmatogenous retinal detachment with sickling retinopathy, but also for patients undergoing pars plana vitrectomy who may require scierai buckling.
VOL. 92, NO. 4
NOTES, CASES, INSTRUMENTS
REFERENCES 1. Goldberg, M. F. : Classification and pathogenesis of proliferative sickle retinopathy. Am. J. Oph thalmol. 71:649, 1971. 2. Ryan, S. J., and Goldberg, M. F.: Anterior segment ischemia following scierai buckling in sickle cell hemoglobinopathy. Am. J. Ophthalmol. 72:35, 1971.
583
3. Kernoff, M., Botha, M., and Jacobs, P.: Ex change transfusion in sickle cell disease using a continuous-flow blood separator. Transfusion 17:269, 1977. 4. Key, T., Horger, E., Walker, E., and Mitchum, E.: Automated erythrocytopheresis for sickle cell anemia during pregnancy. Am. J. Obstet. Gynecol. 7:731, 1980.