目的:评价光学相干断层扫描血管造影(OCTA)检测糖尿病患者眼内微血管早期改变的有效性。
方法:在PubMed上进行了系统研究搜索,Medline,Embase,还有Cochrane图书馆,2012年1月至2023年3月。对照研究将患有非糖尿病性视网膜病变(NDR)的糖尿病(DM)患者或患有轻度非增生性糖尿病性视网膜病变(轻度NPDR)的患者与健康人进行了比较。这些研究包括OCTA的参数,如中央凹无血管区(FAZ),浅表毛细血管丛血管密度(VDscp),深毛细血管丛血管密度(VDDcp),和乳头周围VD。根据异质性使用相关效应模型,并计算平均差和95%置信区间。
结果:共有18项2101只眼的研究最终纳入了该荟萃分析。我们的结果表明,VDscp的早期改变,VDDcp,通过OCTA,NDR患者的乳头周围VD与健康人相比有显着性差异(VDscp:WMD=-1.34,95%CI:-1.99至-0.68,P<0.0001。VDDcp:WMD=-2.00,95%CI:-2.95至-1.04,P<0.0001。乳头周围VD:WMD=-1.07,95%CI:-1.70至-0.43,P=0.0010)。然而,两组总FAZ比较差异无统计学意义(WMD=-0.00,95%CI:-0.02~0.01,P=0.84)。此外,对于轻度NPDR的患者,OCTA可以说明VDscp的显著变化,VDDcp,与健康人相比(VDscp:WMD=-6.11,95%CI:-9.90至-2.32,P=0.002。VDDcp:WMD=-4.26,95%CI:-5.95至-2.57,P<0.00001。FAZ:WMD=0.06,95%CI:0.01-0.11,P=0.03)。
结论:在有或没有视网膜病变的糖尿病患者中,OCTA的参数,如VDscp,VDDcp,和乳头周围血管密度被证明是监测视网膜微血管病变早期改变的潜在生物标志物,而在没有视网膜病变的糖尿病患者中,总FAZ可能没有显著变化。
OBJECTIVE: To evaluate the effectiveness of optical coherence tomography angiography (OCTA) in detecting early intraocular microvascular changes in diabetic patients.
METHODS: A systematic study search was performed on PubMed, Medline, Embase, and the Cochrane Library, ranging from January 2012 to March 2023. Controlled studies compared diabetes mellitus (DM) patients with non-diabetic retinopathy (NDR) or patients with mild non-proliferative diabetic retinopathy (mild NPDR) to healthy people. These studies included parameters of OCTA such as foveal avascular zone (FAZ), vessel density of superficial capillary plexus (VDscp), vessel density of deep capillary plexus (VDdcp), and peripapillary VD. The relevant effect model was used according to the heterogeneity, and the mean difference and 95% confidence intervals were calculated.
RESULTS: A total of 18 studies with 2101 eyes were eventually included in this meta-analysis. Our results demonstrated that early alterations of VDscp, VDdcp, and peripapillary VD in NDR patients had a significant difference compared with healthy people by OCTA (VDscp: WMD = -1.34, 95% CI: -1.99 to -0.68, P < 0.0001. VDdcp: WMD = -2.00, 95% CI: -2.95 to -1.04, P < 0.0001. Peripapillary VD: WMD = -1.07, 95% CI: -1.70 to -0.43, P = 0.0010). However, there was no statistically significant difference in total FAZ between them (WMD = -0.00, 95% CI: -0.02-0.01, P = 0.84). In addition, for patients with mild NPDR, OCTA could illustrate prominent changes in VDscp, VDdcp, and total FAZ compared with healthy people (VDscp: WMD = -6.11, 95% CI: -9.90 to -2.32, P = 0.002. VDdcp: WMD = -4.26, 95% CI: -5.95 to -2.57, P < 0.00001. FAZ: WMD = 0.06, 95% CI: 0.01-0.11, P = 0.03).
CONCLUSIONS: In diabetic patients with or without retinopathy, the parameters of OCTA such as VDscp, VDdcp, and peripapillary vessel density were demonstrated as potential biomarkers in monitoring the early alterations of retinal microangiopathy, while total FAZ may have no significant changes in diabetic patients without retinopathy.