A 19-year-old man with sickle cell disease undergoes routine fundoscopy. The peripheral retina shows a fan-shaped tuft of fine neovascular vessels growing from the equator toward the ora serrata, and a flat pigmented chorioretinal scar elsewhere in the periphery. Which sequence of lesions does this represent?

• A Salmon patch haemorrhage followed by black sunburst
• B Sunburst lesion followed by iridescent spot formation
• C Sea fan neovascularisation arising after peripheral arteriolar occlusion ✓
• D Comma-shaped conjunctival vessel extending into the retina

Explanation

In proliferative sickle retinopathy, sickled erythrocytes occlude peripheral precapillary arterioles, creating areas of non-perfusion. Neovascular fronds then grow at the border of perfused and non-perfused retina, forming the classic sea fan configuration. These fronds are fragile and can cause vitreous haemorrhage or tractional retinal detachment. Salmon patch haemorrhages are intraretinal bleeds that evolve into iridescent spots and finally into the black sunburst scars seen in this patient, confirming prior peripheral ischaemia.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.