Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Parkinsonism Relat Disord. 2019 Jul;64:40-49. doi: 10.1016/j.parkreldis.2019.04.023. Epub 2019 Apr 30.
Patients with Parkinson's disease experience visual symptoms, partially originating from retinal changes. Since 2011, multiple case-control studies using spectral-domain OCT, which allows for studying individual retinal layers, have been published. The aim of this study was to substantiate the occurrence, extent, and location of retinal degeneration in Parkinson's by meta-analysis.
Spectral-domain OCT case-control data were collected by performing a search in PubMed and Embase with terms: "optical coherence tomography" and "parkinson", up to November 5th, 2018. Studies with fewer than 10 patients or controls were excluded. We performed a random effects meta-analysis. Heterogeneity was evaluated with I statistics; publication bias with Egger's and Begg's tests.
Out of 77 identified studies, 36 were included, totaling 1916 patients and 2006 controls. A significant thinning of the peripapillary retinal nerve fiber layer (d = -0.42; 95% confidence interval -0.54 to -0.29) and the combined ganglion cell and inner plexiform layers (d = -0.40; -0.72, to -0.07) was found. The inner nuclear layer and outer plexiform layer did not show significant changes. Heterogeneity ranged from 3 to 92%; no publication bias was found.
Parkinson's patients show significant thinning of the inner retinal layers, resembling changes found in glaucoma and other neurodegenerative diseases like Alzheimer's. Study of different cell layers in-vivo is possible by moving from time-to spectral domain OCT. Retinal degeneration may be affiliated with neurodegenerative pathology overall, and could serve as a biomarker in neurodegenerative disorders. Longitudinal research including clinical correlations is needed to determine usefulness in Parkinson's disease.
帕金森病患者会出现视觉症状，部分源自视网膜变化。自 2011 年以来，已有多项使用频域光相干断层扫描（可用于研究个体视网膜层）的病例对照研究发表。本研究旨在通过荟萃分析证实帕金森病患者的视网膜变性的发生、程度和位置。
通过在 PubMed 和 Embase 中使用“光学相干断层扫描”和“帕金森”等术语进行搜索，收集频域光相干断层扫描病例对照数据，截至 2018 年 11 月 5 日。排除了病例或对照少于 10 例的研究。我们进行了随机效应荟萃分析。使用 I 统计量评估异质性；使用 Egger 和 Begg 检验评估发表偏倚。
在 77 项已确定的研究中，有 36 项研究被纳入，共纳入 1916 例患者和 2006 例对照。发现视盘周围视网膜神经纤维层（d= -0.42；95%置信区间 -0.54 至 -0.29）和联合节细胞和内丛状层（d= -0.40；-0.72，至 -0.07）变薄。内核层和外丛状层没有显示出明显的变化。异质性范围为 3%至 92%；未发现发表偏倚。
帕金森病患者的内层视网膜明显变薄，类似于青光眼和其他神经退行性疾病（如阿尔茨海默病）中发现的变化。通过从时域光相干断层扫描转移到频域光相干断层扫描，可以对不同的细胞层进行活体研究。视网膜变性可能与整体神经退行性病理学有关，并可作为神经退行性疾病的生物标志物。需要进行包括临床相关性的纵向研究，以确定其在帕金森病中的用途。
