Department of Eye & Vision Sciences, University of Liverpool, Liverpool, UK.
Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi.
Malar J. 2023 Apr 26;22(1):139. doi: 10.1186/s12936-023-04566-7.
Cerebral malaria (CM) continues to present a major health challenge, particularly in sub-Saharan Africa. CM is associated with a characteristic malarial retinopathy (MR) with diagnostic and prognostic significance. Advances in retinal imaging have allowed researchers to better characterize the changes seen in MR and to make inferences about the pathophysiology of the disease. The study aimed to explore the role of retinal imaging in diagnosis and prognostication in CM; establish insights into pathophysiology of CM from retinal imaging; establish future research directions.
The literature was systematically reviewed using the African Index Medicus, MEDLINE, Scopus and Web of Science databases. A total of 35 full texts were included in the final analysis. The descriptive nature of the included studies and heterogeneity precluded meta-analysis.
Available research clearly shows retinal imaging is useful both as a clinical tool for the assessment of CM and as a scientific instrument to aid the understanding of the condition. Modalities which can be performed at the bedside, such as fundus photography and optical coherence tomography, are best positioned to take advantage of artificial intelligence-assisted image analysis, unlocking the clinical potential of retinal imaging for real-time diagnosis in low-resource environments where extensively trained clinicians may be few in number, and for guiding adjunctive therapies as they develop.
Further research into retinal imaging technologies in CM is justified. In particular, co-ordinated interdisciplinary work shows promise in unpicking the pathophysiology of a complex disease.
脑型疟疾（CM）仍然是一个主要的健康挑战，特别是在撒哈拉以南非洲地区。CM 与具有诊断和预后意义的特征性疟原虫视网膜病变（MR）有关。视网膜成像技术的进步使研究人员能够更好地描述 MR 中观察到的变化，并对疾病的病理生理学做出推断。本研究旨在探讨视网膜成像在 CM 诊断和预后中的作用；从视网膜成像中获得对 CM 病理生理学的深入了解；确定未来的研究方向。
使用非洲医学索引、MEDLINE、Scopus 和 Web of Science 数据库系统地回顾了文献。共有 35 篇全文纳入最终分析。由于研究的描述性性质和异质性，排除了荟萃分析。
现有研究清楚地表明，视网膜成像既是评估 CM 的临床工具，也是帮助理解该疾病的科学工具，具有重要作用。可以在床边进行的成像模式，如眼底照相和光学相干断层扫描，最适合利用人工智能辅助图像分析，在资源有限的环境中实现视网膜成像的临床潜力，实现实时诊断，因为这些环境中可能缺乏受过广泛训练的临床医生，并且可以指导辅助治疗的开展。
有理由对 CM 中的视网膜成像技术进行进一步研究。特别是，协调的跨学科工作有望揭示复杂疾病的病理生理学。
