Vascular dynamics in diabetic retinopathy: A systematic review and meta-analysis of ophthalmic Doppler indices in diabetic and non-diabetic populations
Muchtar Hanafi, Tonang Dwi Ardyanto, Widiastuti Soewondo, Eti Poncorini Pamungkasari, Muthmainah, Wachid Putranto, Senyum IndrakilaBackground
Ophthalmic Doppler ultrasonography is a non-invasive technique for evaluating hemodynamic changes in diabetic patients. This meta-analysis assessed ophthalmic Doppler indices in diabetic patients with and without retinopathy compared to non-diabetic controls.
Methods
We searched Scopus, PubMed, ScienceDirect, and SpringerLink for studies investigating Doppler ultrasound parameters in diabetic retinopathy (DR). Pooled mean differences with 95% confidence intervals were estimated using random-effects models for peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI). Study quality was assessed using QUADAS-2 and QUADAS-C.
Results
Fourteen studies (1,217 patients) were included. People with diabetes without retinopathy showed significantly elevated RI (MD 0.08, P=0.004) and PI (MD 0.30, P<0.0001) in the ophthalmic artery versus controls. The central retinal artery showed marked reductions in PSV and EDV (P<0.00001) and increased RI (P=0.001) in established DR. RI was also elevated in the posterior ciliary artery across all diabetic stages. Diagnostic accuracy analyses yielded pooled RI sensitivity of 0.73–1.00 and PI sensitivity of 0.79–1.00.
Conclusion
Ophthalmic artery Doppler indices, particularly RI and PI, were associated with DR severity that may represent possible additional markers of microvascular dysfunction. However, these findings require confirmation in well-designed prospective studies before RI and PI can be considered established early markers.