Retinal microvasculature features in patients with Behcet’s disease: a systematic review and meta-analysis

Abstract

This meta-analysis aimed to analyze retinal microvasculature features in eyes with Behçet’s disease (BD) using optical coherence tomography angiography (OCTA). Electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, were comprehensively searched for published studies comparing retinal microvasculature characteristics between eyes with BD and controls. Continuous variables were calculated using the mean difference (MD) with 95% confidence interval (CI). Review Manager software (version 5.30) was used to conduct statistical analysis. A total of 13 eligible studies involving 599 eyes with BD and 622 control eyes were included in the meta-analysis. The pooled results showed that the macular whole enface superficial and deep vessel density (VD) values measured by OCTA were significantly lower in eyes with BD than in control eyes (superficial VD: MD = − 3.05, P < 0.00001; deep VD: MD = − 4.05, P = 0.0004). The foveal superficial and deep VD values were also significantly lower in the BD group than in the control group (superficial VD: MD = − 1.50, P = 0.009; deep VD: MD = − 4.25, − = 0.03). Similarly, the analysis revealed a significant reduction in the parafoveal superficial and deep VD in eyes with BD than in control eyes (superficial VD: MD = − 3.68, P < 0.00001; deep VD: MD = − 4.95, P = 0.0007). In addition, the superficial and deep foveal avascular zones (FAZs) were significantly larger in patients with BD than in controls (superficial FAZ: MD = 0.06, P = 0.02; deep FAZ: MD = 0.12, P = 0.03). The present meta-analysis found that macular whole enface VD, foveal VD, and parafoveal VD were lower in eyes with BD, and the FAZ was larger in patients with BD. The findings suggest that OCTA can assist clinicians in diagnosing and monitoring the status of patients with BD.

Uveitis in Behçet disease - an update

“…In a meta-analysis of cross-sectional studies comparing OCT-A findings between BD patients without ocular involvement and healthy controls, a significantly lower parafoveal capillary density and a larger foveal avascular zone (FAZ) have been reported in BD patients [35]. In another meta-analysis of OCT-A studies including BD patients with or without ocular involvement, the authors reported a high heterogeneity of results; yet pooled data showed significantly lower vessel densities in both superficial and deep parafoveal capillary plexus as well as enlarged FAZ in BD patients with ocular involvement and similar findings also in those without [36]. In a small longitudinal study, OCT-A showed significantly increased vessel density in superficial foveal capillary plexus, yet an enlarged FAZ after remission of BD uveitis [37].…”

“…Therefore, OCT-A cannot replace FA in monitoring BD uveitis. Nevertheless, several OCT-A studies have been recently published, suggesting its use as an adjunctive imaging modality in BD uveitis [35–38]. In a meta-analysis of cross-sectional studies comparing OCT-A findings between BD patients without ocular involvement and healthy controls, a significantly lower parafoveal capillary density and a larger foveal avascular zone (FAZ) have been reported in BD patients [35].…”

A systematic review of OCT and OCT angiography in retinal vasculitis

“…One study reported the specificity of OCT-A to detect capillary dropout in superficial and deep capillary plexuses was 97% and 94% [ 35 ], but the very low sensitivity will mean OCT-A will miss a high proportion with non-perfusion on fluorescein angiography. Capillary vessel density was also explored in a recent meta-analysis in Behcet's patients regardless of retinal vasculitis [ 55 ] and showed decreased deep and superficial capillary vessel density in Behcet's disease.…”

Retinal microvascular and microstructural alterations in the diagnosis of dermatomyositis: a new approach

“…The discrepancy in results may be due to the distinction of manifestations among different populations or the different stages of the disease. Several studies of CTDs have found that the involvement of DVD occurs earlier than that of SVD ( 34 , 40 , 41 ). In the future, longitudinal studies defining the stages of the disease may be more convincing.…”