He Xing-Yu, Chen Wei-Wei, Wang Qian
Department of Ophthalmology, the Third People's Hospital of Chengdu, Chengdu 610000, Sichuan Province, China.
Department of Ophthalmology, Chengdu Medical College Chengdu Seventh People's Hospital, Chengdu 610000, Sichuan Province, China.
Int J Ophthalmol. 2025 Jul 18;18(7):1375-1382. doi: 10.18240/ijo.2025.07.22. eCollection 2025.
To summarize and quantitatively evaluate vasculature alteration of foveal zone in systemic lupus erythematosus (SLE) patients by secondary literature analysis.
A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI WanFang Data and VIP was conducted. Studies were about retinal vessel density in SLE patients from January 2000 to April 2023 and valid data were extracted. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the cross-sectional studies and prospective studies. The measurement data for combined effect size were weighted mean difference (WMD) and 95% confidence interval (CI). The heterogeneity was evaluated by test. The fixed-effect model was adopted when >0.1 or <50%, and random-effect model was adopted in the contrary. Subgroup and sensitivity analysis were utilized to analyze the sources of heterogeneity. The publication bias was evaluated by Egger tests and funnel plots.
A total of 14 studies with 445 subjects and 441 healthy controls from 9 countries were enrolled and 11 studies were included in Meta-analysis. The JBI scores of studies were no less than 14 points. The Meta-analysis results indicated that mean parafoveal superficial vessel density (SVD; WMD=-1.22, 95%CI: -1.67, -0.76), mean perifoveal SVD (WMD=-1.42, 95%CI: -1.95, -0.89), mean whole SVD (WMD=-1.66, 95%CI: -2.53, -0.79), mean parafoveal deep vessel density (WMD=-1.67, 95%CI: -2.75, -0.59) and mean whole deep vessel density (WMD=-4.09, 95%CI: -7.67, -0.52) was significantly lower than the control, while mean foveal SVD (WMD=-1.71, 95%CI: -4.65, 1.24), mean foveal avascular zone (FAZ) area (WMD=0.04, 95%CI: -0.01, 0.09) and mean acircularity index (AI; WMD=0.00, 95%CI: -0.02, 0.02) were not different between SLE patients and controls. Subgroup analysis indicated that the heterogeneity in SVD was partially due to the scanning area. Ocellus or binoculus data contributed partially to the heterogeneity in parafoveal deep vessel density and FAZ area. Sensitivity analysis indicated that the results were robust after changing the analysis model except for foveal SVD and FAZ area. There was no bias in included studies except whole SVD.
Parafoveal superficial and deep vessel density are significantly lower in SLE patients while FAZ area and AI are not different between SLE patients and the control.
通过二次文献分析总结并定量评估系统性红斑狼疮（SLE）患者黄斑区的血管改变。
对PubMed、Embase、Web of Science、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国知网、万方数据和维普资讯进行系统检索。纳入2000年1月至2023年4月关于SLE患者视网膜血管密度的研究并提取有效数据。采用乔安娜布里格斯研究所（JBI）批判性评价清单对横断面研究和前瞻性研究进行评价。合并效应量的计量资料采用加权均数差（WMD）和95%置信区间（CI）。采用 检验评估异质性。当I²>0.1或P<50%时采用固定效应模型，反之采用随机效应模型。采用亚组分析和敏感性分析探讨异质性来源。采用Egger检验和漏斗图评估发表偏倚。
共纳入来自9个国家的14项研究，445例受试者和441例健康对照，11项研究纳入Meta分析。研究的JBI评分均不低于14分。Meta分析结果显示，与对照组相比，SLE患者黄斑旁浅表血管密度（SVD）均值（WMD=-1.22，95%CI：-1.67，-0.76）、黄斑周围SVD均值（WMD=-1.42，95%CI：-1.95，-0.89）、全层SVD均值（WMD=-1.66，95%CI：-2.53，-0.79）、黄斑旁深层血管密度均值（WMD=-1.67，95%CI：-2.75，-0.59）和全层深层血管密度均值（WMD=-4.09，95%CI：-7.67，-0.52）显著降低，而黄斑中心凹SVD均值（WMD=-1.71，95%CI：-4.65，1.24）、黄斑中心凹无血管区（FAZ）面积均值（WMD=0.04，95%CI：-0.01，0.09）和平均非圆度指数（AI；WMD=0.00，95%CI：-0.02，0.02）在SLE患者和对照组之间无差异。亚组分析表明，SVD的异质性部分归因于扫描区域。单眼或双眼数据部分导致了黄斑旁深层血管密度和FAZ面积的异质性。敏感性分析表明，除黄斑中心凹SVD和FAZ面积外，改变分析模型后结果稳健。除全层SVD外，纳入研究无发表偏倚。
SLE患者黄斑旁浅表和深层血管密度显著降低，而FAZ面积和AI在SLE患者和对照组之间无差异。
