Lohrasbi Fatemeh, Karimi Elaheh, Gouravani Mahdi, Fooladi Sarabi Shahnaz, Mafi Amirreza, Beikmarzehei Alireza, Sanjari Moghaddam Hossein, Parsaei Mohammadamin, Tabatabaei Seyed Mehdi, Arevalo J Fernando
School of Medicine, Babol University of Medical Sciences, Babol, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Ophthalmic Res. 2025;68(1):23-40. doi: 10.1159/000542413. Epub 2024 Nov 4.
Optical coherence tomography angiography (OCTA) is an emerging technique to investigate retinal and choroidal microvascular alterations in patients with systemic sclerosis (SSc). This systematic review and meta-analysis aimed to evaluate the features of retinal and choroidal microvasculature using OCTA among SSc patients.
The methodology of the study was based on PRISMA guidelines. PubMed, Scopus, Web of Science, and Embase were searched systematically on November 25, 2023, for relevant studies utilizing OCTA as the main diagnostic tool to assess the retinal and choroidal microvasculature in SSc patients versus healthy controls. Random-effect or fixed model meta-analysis was used based on the heterogeneity of studies.
Eleven observational comparative studies, including 366 patients with SSc and 350 healthy controls, conducted between 2020 and 2023, were included in this review. Meta-analysis findings revealed a significant decrease in vessel densities in both the superficial and deep capillary plexuses among SSc patients compared to controls. However, there were no significant differences observed in the foveal avascular zone area and choriocapillaris flow area between SSc patients and controls. Moreover, central macular thickness (CMT) consistently exhibited a decrease in SSc patients, while retinal nerve fiber layer thickness showed no significant differences. Although radial peripapillary capillary vessel density, subfoveal choroidal thickness, and cup/disk ratio yielded mixed results, with some studies indicating significant changes in the SSc group, meta-analysis could not be performed due to variations in the OCTA machines used across the included studies.
This systematic review demonstrates retinal and choroidal microvascular abnormalities in SSc using OCTA. Longitudinal studies are needed to understand how these abnormalities evolve over time in patients with SSc and whether these abnormalities correlate with the clinical features of SSc.
光学相干断层扫描血管造影（OCTA）是一种用于研究系统性硬化症（SSc）患者视网膜和脉络膜微血管改变的新兴技术。本系统评价和荟萃分析旨在评估SSc患者中使用OCTA检测的视网膜和脉络膜微血管特征。
本研究方法基于PRISMA指南。于2023年11月25日系统检索了PubMed、Scopus、科学网和Embase，以查找利用OCTA作为主要诊断工具评估SSc患者与健康对照者视网膜和脉络膜微血管的相关研究。根据研究的异质性采用随机效应或固定模型荟萃分析。
本评价纳入了2020年至2023年间进行的11项观察性对比研究，包括366例SSc患者和350例健康对照者。荟萃分析结果显示，与对照组相比，SSc患者浅表和深部毛细血管丛的血管密度显著降低。然而，SSc患者与对照组之间在黄斑无血管区面积和脉络膜毛细血管血流面积方面未观察到显著差异。此外，SSc患者的中心黄斑厚度（CMT）持续降低，而视网膜神经纤维层厚度无显著差异。尽管视乳头周围放射状毛细血管血管密度、黄斑下脉络膜厚度和杯盘比结果不一，一些研究表明SSc组有显著变化，但由于纳入研究中使用的OCTA机器不同，无法进行荟萃分析。
本系统评价通过OCTA证实了SSc患者存在视网膜和脉络膜微血管异常。需要进行纵向研究以了解这些异常在SSc患者中如何随时间演变，以及这些异常是否与SSc的临床特征相关。
