Vienne-Jumeau Aliénor, Bremond-Gignac Dominique, Robert Matthieu P
Department of Ophthalmology, Necker-Enfants malades University Hospital, AP-HP, Paris, France.
Centre Borelli, UMR 9010, CNRS-SSA-ENS Paris-Saclay, Université Paris Cité, Paris, France.
Eye (Lond). 2025 Feb;39(2):228-237. doi: 10.1038/s41433-024-03451-0. Epub 2024 Nov 2.
The pathophysiology of optic disc drusen (ODD) has long been discussed. According to one leading theory, they develop from calcified mitochondria extruded from axons compressed by an unusually small scleral canal. To examine this hypothesis, we conducted a systematic review and meta-analysis evaluating the scleral canal size in patients with ODD (PO) in comparison to healthy subjects (HS). We searched MEDLINE, Cochrane Central, EMBASE and gray literature to identify relevant articles. A subgroup analysis compared patients with buried ODD (PO) and patients with visible ODD (PO). The study was registered with the International Prospective Register of Systematic Reviews on December 9th, 2022 (Registration: CRD42022375110). We included fifteen articles in the review and fourteen in the meta-analysis. The mean diameter of the scleral canal computed using both fundus photography (D) and spectral-domain with enhanced depth imaging optical coherence tomography (D) was significantly smaller in PO compared to HS (standardized mean difference -1.21 [-1.85 to -0.56] and -0.66 [-0.94 to -0.37] respectively). D, but not D, was higher in PO as compared to PO. When including all-generation OCT in the analysis, the difference between PO and PO, but not between PO and HS, remained. Several intertwined hypotheses can explain these subgroup and sensitivity results: an enlargement of the canal as the ODD grow, an enlargement with time, or a measurement bias (artefactual enlargement of the canal due to a posterior shadow on OCT). In conclusion, this review and meta-analysis further supports the role of a small scleral canal in the development of ODD.
视盘小疣（ODD）的病理生理学长期以来一直备受讨论。根据一种主流理论，它们由异常狭窄的巩膜管挤压轴突后挤出的钙化线粒体发展而来。为检验这一假说，我们进行了一项系统评价和荟萃分析，评估ODD患者（PO）与健康受试者（HS）的巩膜管大小。我们检索了MEDLINE、Cochrane中心、EMBASE和灰色文献以识别相关文章。亚组分析比较了隐匿性ODD患者（PO）和显性ODD患者（PO）。该研究于2022年12月9日在国际系统评价前瞻性注册库注册（注册号：CRD42022375110）。我们纳入了15篇文章进行综述，14篇文章进行荟萃分析。与HS相比，PO组使用眼底照相术（D）和增强深度成像光谱域光学相干断层扫描（D）计算的巩膜管平均直径显著更小（标准化均差分别为-1.21 [-1.85至-0.56]和-0.66 [-0.94至-0.37]）。与PO相比，PO组的D值较高，但D值不高。在分析中纳入所有代的OCT时，PO组和PO组之间的差异仍然存在，但PO组和HS组之间的差异不存在。有几个相互交织的假说可以解释这些亚组和敏感性结果：随着ODD增大，巩膜管扩大；随时间扩大；或测量偏差（由于OCT上的后部阴影导致巩膜管人为扩大）。总之，这项综述和荟萃分析进一步支持了狭窄巩膜管在ODD发生中的作用。
