Proliferative sickle cell retinopathy (PSR) can lead to visual loss from vitreous haemorrhage and traction or rhegmatogenous retinal detachment. We review two techniques of photocoagulation for PSR, feeder vessel photocoagulation and scatter photocoagulation. A prospective randomised trial of feeder vessel photocoagulation for PSR demonstrated that the incidence of vitreous haemorrhage and visual loss was diminished in eyes which were treated. Since this technique of treatment is difficult and can be associated with choroidal neovascularisation and retinal tears, scatter photocoagulation has also been tested. A prospective randomised trial of scatter photocoagulation for PSR demonstrated a decreased incidence of vitreous haemorrhage and visual loss in treated eyes compared to untreated eyes. No complications of scatter treatment were noted. We presently recommend local scatter photocoagulation to areas of PSR. In unreliable patients, we recommend 360 degrees of peripheral circumferential treatment as otherwise new seafans will develop. If scatter photocoagulation does not result in sufficient regression of the neovascularisation and vision threatening complications such as vitreous haemorrhage continue, feeder vessel treatment can be used to supplement the scatter treatment.
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