Leg ulcers are associated with an increased risk of Sickle eye disease in Lagos

ABSTRACT Key PointPatients with sickle cell Leg ulcers are 5.9 times more likely to develop sickle retinopathy. Leg ulcers are a common sign in Sickle Cell Disease. But to what extent are they indicative of Sickle cell eye disease in these patients? This short communication assesses to what extent leg ulcers predict the presence of sickle eye disease in Nigerian patients.This was a clinic based, comparative non-interventional study, conducted at both the Hematology Clinic and Eye clinic in Lagos University Teaching Hospital (LUTH). One hundred consecutive cases of Sickle Cell Disease (SCD) patients (HbSS and HbSC) attending the Haematology Clinic were compared with 100 age and sex matched non-SCD HbAA controls. The presence of leg ulcers was sought in both groups, and all had assessment for ocular anterior and posterior signs of SCD. Cases and controls were comparable in age and sex. Amongst 100 Cases, 85 were HbSS and 15 HbSC. Leg ulcers were present in 18 patients. Eighty-two cases had either anterior or posterior SCD related ocular manifestations. Patients with leg ulcer were found to be at higher risk of developing Conjunctival Sickle Sign, Retinal Venous Tortuosity and Proliferative Sickle Retinopathy with an increased likelihood of 22.9, 7.1 and 5.9 times respectively. We believe this is the first study to quantify this association. ConclusionsThis study suggests that sickle cell eye disease is more likely to develop in sickle cell disease patients with leg ulcers. Internists managing SCD patients are advised to refer patients with leg ulcers for early ocular assessment in order to prevent complications.