Optical Coherence Tomography Angiography in Early Detection of Microvascular Changes in Type I Diabetic Children: A Systematic Review and Meta-Analysis, ROFYDA O. FATHALLAH, HUSSEIN Sh. EL MARKABI, RASHA ADEL THABET and MARIAM AL-FEKY
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Optical Coherence Tomography Angiography in Early Detection of Microvascular Changes in Type I Diabetic Children: A Systematic Review and Meta-Analysis, ROFYDA O. FATHALLAH, HUSSEIN Sh. EL MARKABI, RASHA ADEL THABET and MARIAM AL-FEKY
Abstract
Background: Diabetic retinopathy (DR) remains a leading cause of blindness worldwide, with the pediatric population being no exception. Early diagnosis and monitoring of the disease is a pressing need. Optical coherence tomography angiography (OCTA) is a recent, non-invasive tool that allows for evaluation of the fundus microvasculature. Little is known about the efficacy of OCTA in detection of early changes in eyes with no clinical signs of DR. Aim of Study: The aim of this work was to systematically review the literature to detect on the efficacy of OCTA in early detection of retinal microvascular changes in the eyes of children with type I DM that show no clinical signs of DR. Patients and Methods: This was a systematic review of the literature. A total of 217 screened citations were reviewed and seven studies met our inclusion criteria. The total included cases were 708 (1228 eyes). The main outcome measures were foveal a vascular zone (FAZ) area and perimeter, a circularity index, non-flow area (mm2), foveal density (%), superficial capillary plexus (SCP) density, and deep capillary plexus (DCP) density.We excluded studies that did not fulfill the pre-specified inclusion criteria. Included studies underwent quality assessment based on ethical aspects, eligibility criteria, availability of appropriate controls, and availability of adequate information and clearly defined assessment measures. Results: Our analysis identified multiple potential biomar-kers that could detect early DR in diabetic patients, namely: FAZ perimeter (MD=0.10, 95%CI=[0.03, 0.17], I2=31%, value=0.23) and foveal density (MD=–1.48, 95%CI=[–2.27, -0.70], I2=15%, value=0.28). Further, pooled data regarding vessels densities showed a trend towards a lower SCP vessel densities in the whole retina and in the parafoveal area (MD=–0.96, 95%CI=[–1.38, –0.55], I2=32%, value=0.23 and MD=–0.87, 95%CI=[–1.20, –0.53], I2=0%, value=0.82, re-spectively) and lower DCP vessel densities in parafoveal area (MD=–1.02, 95%CI=[–1.35, –0.70], I2=8%, p-value=0.35), although none were statistically significant. Conclusion: OCTA can potentially be utilized for early detection of changes in the FAZ perimeter, SCP and DCP densities in the eyes prior to the clinical evidence of DR, and the progressive changes secondary to disease progression. Additional studies including larger samples are warranted.