Capillary nonperfusion by novel technology of OCT angiography in a patient with sickle cell disease with normal fluorescein angiogram.

Purpose: Retinal ischemia is a pathophysiologic feature of sickle cell retinopathy. Inner retinal thinning of retina temporal to the fovea has been reported on spectral-domain optical coherence tomography (SD-OCT) even though clinical examination is normal and fluorescein angiography (FA) does not show any capillary dropout. In a patient with sickle cell disease with temporal inner retinal thinning on SD-OCT and normal FA, the new technology of OCT angiography (OCTA) showed a corresponding area of nonperfusion.

Methods: The patient with sickle cell disease underwent visual acuity testing, refraction, slit-lamp biomicroscopy, and dilated fundus examination. The patient also underwent SD-OCT, digital FA, and OCTA. The findings are described in this case report.

Results: In this patient with sickle cell disease, although clinical examination was normal and FA did not show any capillary dropout, the SD-OCT showed inner retinal thinning temporal to the fovea. Corresponding to this area, OCTA showed an area of nonperfusion.

Conclusions: Optical coherence tomography angiography technology may be more sensitive than the gold standard FA in identifying retinal ischemia in patients with sickle cell disease.