In sickle cell retinopathy (SCR), the Goldberg classification Stage IV refers to:

• A Arteriovenous anastomoses with peripheral arterial occlusions
• B 'Sea fan' neovascularization (proliferative sickle retinopathy — PSR) with tractional or rhegmatogenous retinal detachment
• C Peripheral retinal ischemia with silver-wire arterioles but no neovascularization
• D Vitreous hemorrhage from neovascular frond rupture ✓

Explanation

The Goldberg classification of sickle cell retinopathy has five stages: Stage I — peripheral arterial occlusions; Stage II — peripheral arteriovenous anastomoses (to bypass occluded arteries); Stage III — sea-fan neovascularization (proliferative sickle retinopathy — PSR), the seafan-shaped NVE at the junction of perfused and non-perfused retina; Stage IV — vitreous hemorrhage from traction/rupture of sea-fan fronds; Stage V — tractional and/or rhegmatogenous retinal detachment. Stage V is the most severe with lowest visual prognosis. The PSR (Stage III) has a unique feature of spontaneous auto-infarction in up to 60% of cases (neovascular fronds thrombose), potentially preventing progression — different from diabetic NVE.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.