光学相干断层扫描血管造影对DR诊断价值的Meta分析

A Meta-analysis of the diagnostic value of optical coherence tomography angiography in DR

目的:应用光学相干断层血管造影(OCTA)评估糖尿病视网膜病变(DR)患者中心凹无血管区(FAZ)和血管密度(VD)的变化。方法:对OCTA在DR诊断中的应用文献进行系统回顾。搜索Medline、Embase、Web of Science、PubMed、中国知网数据库、万方数据库以查找相关研究,检索时间从建库截止到2020-09-20。仅检索中英文文献。两名研究者分别独立提取文献资料,包括浅层视网膜毛细血管层血管线性密度(VDSCP)、深层视网膜毛细血管层血管线性密度(VDDCP)、浅层FAZ面积和周长。绘制森林图、漏斗图,并采用Begg检验和敏感性分析,确保结果的准确性。结果:共检索得24篇文献,纳入2305眼。结果显示,糖尿病患者与健康对照组各指标均有差异(VDSCP:WMD=-5.78,95%CI:-7.67~-3.88,P<0.05;VDDCP:WMD=-5.08,95%CI:-6.49~-3.67,P<0.05;FAZ周长:WMD=0.57,95%CI:0.36~0.78,P<0.05;FAZ面积:WMD=0.08,95%CI:0.06~0.10,P<0.05)。结论:DR患者FAZ面积更大,周长更长,与DR患者对比,对照组FAZ的VD较高。虽然目前OCTA的实际适用性仍然存在问题,但随着技术的不断发展和改进,OCTA在DR中的诊断价值可能会变得明显。

AIM:To assess the changes of foveal avascular zone(FAZ)and vessel density(VD)using optical coherence tomography angiography(OCTA)in diabetic retinopathy(DR)patients.METHODS:A systematic review of the literature was performed to examine the diagnostic used OCTA in DR to date.Six electronic databases were searched to find relevant studies.We conducted a literature search in English and Chinese databases.Two authors extracted basic data,the VD of superior capillary plexus(VDSCP),the VD of deep capillary plexus(VDDCP),the area and the perimeter of FAZ.We used a variety of Meta-analytic methods,including WMD forest maps,funnel plot,Begg test and sensitivity analysis,to confirm the final results.RESULTS:Totally 24 studies recruiting 2305 eyes were included.Patients with DR showed statistical difference in VDSCP[WMD=-5.78,95%CI(-7.67 to-3.88),P<0.05],VDDCP[WMD=-5.08,95%CI(-6.49 to-3.67),P<0.05],the perimeter of FAZ[WMD=0.57,95%CI(0.36 to 0.78),P<0.05],the area of FAZ[WMD=0.08,95%CI(0.06 to 0.10),P<0.05]with healthy controls.CONCLUSION:In general,there was a trend towards a larger area and longer perimeter of FAZ in patients with DR.It can also be concluded that the VD of FAZ is higher in healthy controls.While questions remain regarding OCTA practical applicability in its present form,with continuing development and improvement of the technology,the diagnostic value of OCTA in DR is likely to become evident.