Background. Diabetic macular edema (DME) is a major cause of vision loss in diabetics that is currently mainly treated by antivascular endothelial growth factor (VEGF) agents. The effect of these agents on macular perfusion (MP) is a current concern. Optical coherence tomography angiography (OCTA) is an imaging modality that allows noninvasive high-resolution retinal microvasculature imaging. Several recent studies evaluated the effect of anti-VEGF agents on the MP of DME patients using OCTA. Our aim is to provide a systematic review of these studies. Methods. Multiple databases were searched including PubMed, Ovid Medline, EMBASE, and Google Scholar for relevant studies published between January 2016 and November 2020 which were included in this review. Studies were compared regarding their design, the number of included patients, the machine and scanning protocol used, the inclusion and exclusion criteria, the number of injections given, the type of anti-VEGF agent used, the outcome measures assessed, and the effect of injections on different MP parameters. Results. A total of 16 studies were included. The studies assessed various OCTA parameters that define MP including the foveal avascular zone area and superficial and deep vascular density and yielded conflicting results. Seven studies showed stable or improved MP following treatment, while 7 studies showed worsening MP following treatment, and 2 studies showed inconclusive results. This could have been due to differences in study design, inclusion criteria, type of anti-VEGF agents used, treatment duration, and methods of image analysis and vascular density quantification. All identified studies were noncomparative case series, and 14 of them (87.5%) used the RTVue XR Avanti OCTA machine. Only one study compared OCTA to fluorescein angiography findings. Conclusion. Analysis of MP changes following VEGF inhibition for DME could benefit from a unified scanning protocol and analysis approach that uses similar study designs to eliminate potential sources of bias. This may provide more definitive conclusions regarding the effect of treatment on MP.

中文翻译：

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抗 VEGF 治疗糖尿病黄斑水肿后黄斑灌注变化的光学相干断层扫描血管造影：系统评价


背景。糖尿病性黄斑水肿（DME）是糖尿病患者视力丧失的主要原因，目前主要通过抗血管内皮生长因子（VEGF）药物进行治疗。这些药物对黄斑灌注（MP）的影响是当前关注的问题。光学相干断层扫描血管造影（OCTA）是一种可进行无创高分辨率视网膜微血管成像的成像方式。最近的几项研究使用 OCTA 评估了抗 VEGF 药物对 DME 患者 MP 的影响。我们的目标是对这些研究进行系统回顾。方法。检索了多个数据库，包括 PubMed、Ovid Medline、EMBASE 和 Google Scholar，查找 2016 年 1 月至 2020 年 11 月期间发表的相关研究，这些研究均纳入本综述。研究的比较包括设计、纳入患者数量、使用的机器和扫描方案、纳入和排除标准、注射次数、使用的抗 VEGF 药物类型、评估的结果指标以及不同 MP 参数的注射。结果。总共纳入了 16 项研究。这些研究评估了定义 MP 的各种 OCTA 参数，包括中心凹无血管区面积以及浅表和深部血管密度，但得出了相互矛盾的结果。 7 项研究显示治疗后 MP 稳定或改善，7 项研究显示治疗后 MP 恶化，2 项研究显示不确定的结果。这可能是由于研究设计、纳入标准、使用的抗 VEGF 药物类型、治疗持续时间以及图像分析和血管密度量化方法的差异所致。所有确定的研究都是非比较性病例系列，其中 14 项（87.5%）使用了 RTVue XR Avanti OCTA 机器。只有一项研究将 OCTA 与荧光素血管造影结果进行了比较。结论。对 DME 抑制 VEGF 后 MP 变化的分析可以受益于统一的扫描方案和分析方法，该方法使用类似的研究设计来消除潜在的偏差来源。这可能会提供关于 MP 治疗效果的更明确的结论。