Department of Community Medicine, Center for Health Technology and Services Research (CINTESIS), Information and Health Decision Sciences (MEDCIDS), University of Porto, Oporto, Portugal
Department of Ophthalmology, Polyclinique de la Baie, Avranches, France.
Br J Ophthalmol. 2019 Nov;103(11):1677-1684. doi: 10.1136/bjophthalmol-2018-313461. Epub 2019 Feb 6.
Compared with current imaging methods, the diagnostic performance and the advantages and limitations of optical coherence tomography angiography (OCTA) remain unclear. We performed a systematic review and meta-analysis of studies investigating vessel density (VD) in patients with glaucoma using OCTA.
We conducted a literature search on PubMed, Scopus, Web of Science, ISI Conference Proceedings and Google Scholar, along with a manual search, from January 2006 to March 2018. We included prospective studies that used OCTA to compare the VD in glaucomatous eyes with healthy control eyes.
Of 3045 screened articles, 24 were included in a broad characterisation and 18 in the meta-analysis. We observed a statistically significant reduction in the mean peripapillary VD (MPVD) in glaucoma (MPVD: 57.53%, 95% CI 52.60 to 62.46, p< 0.001) compared with controls (MPVD: 65.47%, 95% CI 59.82 to 71.11; standardised mean difference [SMD], -1.41, 95% CI -1.62 to -1.20, p< 0.001) for 888 glaucomatous and 475 healthy eyes, and also in the mean-whole optic nerve image VD (SMD, -9.63, 95% CI -10.22 to -9.03, p<0.001), mean inside-disc VD (SMD, - 9.51, 95% CI -12.66 to -6.36, p<0.05) and mean parafoveal VD (SMD, -3.92, 95% CI -4.73 to -3.12, p<0.001). Subgroup analyses revealed a significant difference in the MPVD across glaucoma subtypes and OCTA devices.
This suggests the diagnostic utility of OCTA in detecting glaucomatous eyes; however, further longitudinal prospective studies are welcomed to characterise vascular changes in glaucoma.
与目前的成像方法相比，光相干断层扫描血管造影（OCTA）的诊断性能及其优缺点仍不清楚。我们对使用 OCTA 评估青光眼患者血管密度（VD）的研究进行了系统评价和荟萃分析。
我们对 PubMed、Scopus、Web of Science、ISI 会议录和 Google Scholar 进行了文献检索，并进行了手动检索，检索时间为 2006 年 1 月至 2018 年 3 月。我们纳入了使用 OCTA 比较青光眼患者和健康对照组眼 VD 的前瞻性研究。
在 3045 篇筛选出的文章中，24 篇被广泛描述，18 篇被纳入荟萃分析。与对照组相比（MPVD：65.47%，95%置信区间 59.82%至 71.11%；标准均数差[SMD]，-1.41，95%置信区间-1.62 至-1.20，p<0.001），我们观察到青光眼患者的平均视盘周围 VD（MPVD）存在统计学显著降低（MPVD：57.53%，95%置信区间 52.60%至 62.46%，p<0.001），纳入了 888 例青光眼和 475 例健康眼。在整个视神经图像 VD（SMD，-9.63，95%置信区间-10.22 至-9.03，p<0.001）、视盘内 VD（SMD，-9.51，95%置信区间-12.66 至-6.36，p<0.05）和平均旁中心凹 VD（SMD，-3.92，95%置信区间-4.73 至-3.12，p<0.001）方面也观察到了统计学差异。亚组分析显示，青光眼各亚型和 OCTA 设备之间的 MPVD 存在显著差异。
这表明 OCTA 在检测青光眼患者方面具有诊断价值；然而，我们欢迎进一步的纵向前瞻性研究来描述青光眼患者的血管变化。
