OCTA评价无糖尿病视网膜病变患者黄斑区微循环特征的Meta分析

Meta-analysis of macular microcirculation in patients with no diabetic retinopathy evaluated by OCTA

目的:采用Meta分析的方法,对光学相干断层扫描血管成像技术(OCTA)测量无糖尿病视网膜病变(NDR)的患者黄斑区的血流密度(VD)及浅层中心凹无血管区(FAZ)面积进行系统评价,探讨糖尿病早期视网膜的微循环特征。方法:在PubMed、Embase、Web of Science、Cochrane Library数据库中全面检索发表于2011-01-01/2021-01-05之间关于OCTA分析NDR患者黄斑区不同区域血流密度的研究。比较NDR组与正常对照组(同期年龄、性别与NDR组患者相匹配的健康人群)在浅层旁中心凹血流密度(spafVD)、浅层中心凹周围血流密度(spefVD)、深层旁中心凹血流密度(dpafVD)、深层中心凹周围血流密度(dpefVD)、浅层FAZ面积、最佳矫正视力(BCVA)。结果:研究纳入文献13篇,共1227眼(正常对照组558眼,NDR组669眼)。Meta分析结果显示:与正常对照组相比,NDR组spafVD(MD=-1.90,95%CI:-2.43~-1.37,P<0.00001)、spefVD(MD=-1.29,95%CI:-2.14~-0.44,P=0.003)、dpafVD(MD=-2.18,95%CI:-2.69~-1.67,P<0.00001)、dpefVD(MD=-2.37,95%CI:-3.27~-1.46,P<0.00001)显著降低,其中dpefVD降低更明显;浅层FAZ面积(MD=0.04,95%CI:0.03~0.06,P<0.00001)增大;两组BCVA比较无差异(MD=0.00,95%CI:-0.01~0.02,P=0.44)。结论:黄斑区深层中心凹周围区毛细血管损伤是糖尿病患者视网膜微循环障碍的最早期表现,也是糖尿病视网膜病变临床随访的关键指标。

·AIM:Meta-analysis was performed to systematically evaluate the macular vessel density(VD)and foveal avascular zone(FAZ)areas in patients with no diabetic retinopathy(NDR)by using optical coherence tomography angiography(OCTA).This study aimed to investigate the microcirculatory characteristics of the retina in the early stage of diabetes.·METHODS:PubMed,Embase,Web of Science and Cochrane Library databases were searched for publications from 1 January,2011 to 5 January,2021 on OCTA analysis of VD in different regions of the macular area in diabetic patients with NDR.Compare the differences in the superficial parafoveal VD(spafVD),superficial perifoveal VD(spefVD),deep parafoveal VD(dpafVD),deep perifoveal vessel density(dpefVD),superficial FAZ area and best corrected visual acuity(BCVA)between NDR group and the normal control group(healthy population matched for the age at the same time and gender with patients in the NDR group).·RESULTS:Thirteen publications with a total of 1227 eyes(558 eyes in normal control group and 669 eyes in NDR group)were included in the study.Meta-analysis showed that compared with the control group,NDR group displayed a significant decrease in spafVD(MD=-1.90,95%CI:-2.43--1.37,P<0.00001),spefVD(MD=-1.29,95%CI:-2.14--0.44,P=0.003),dpafVD(MD=-2.18,95%CI:-2.69--1.67,P<0.00001)and dpefVD(MD=-2.37,95%CI:-3.27--1.46,P<0.00001),with a more significant reduction in dpefVD,and superficial FAZ area(MD=0.04,95%CI:0.03-0.06,P<0.00001)was increased.There was no difference in BCVA(MD=0.00,95%CI:-0.01-0.02,P=0.44)between the two groups.·CONCLUSION:Capillary injury in the deep perifoveal region of the macular area is the earliest manifestation of retinal microcirculation disturbance in diabetic patients,and is also a key indicator for clinical follow-up of diabetic retinopathy.