Alterações vasculares da retina na doença de Parkinson detectadas por angiografia por tomografia de coerência óptica – revisão sistemática e metanálise

Abstract

Introduction: Parkinson's disease is a degenerative alteration of the central nervous system, which occurs in a chronic and progressive form, caused by a decrease in the production of dopamine, particularly in the substantia nigra, causing motor and non-motor signs and symptoms, like changes in the visual system. As early diagnosis has been a challenge to control the disease, new research in this field tries to help the identification of patients at an early stage, including from tests such as Optical Coherence Tomography Angiography (OCTA), which assesses the changes retinal vessels. Objectives: Compare, through a systematic review, the retinal vascularization between patients with Parkinson's disease and patients in a control group, assessed by Optical Coherence Tomography Angiography. Methods: A systematic review with meta-analysis was carried out, following the PRISMA criteria, and original articles were included, of studies carried out with patients diagnosed with Parkinson's Disease and healthy controls using OCTA, searched in the MEDLINE search bases (through PUBMED), EMBASE, LILACS and the CAPES Thesis Portal. Main results: 33 references were found, 5 met the criteria and 4 of them demonstrated isolated reduction of the parameters of retinal vascular density in these patients. The meta-analysis included 4 studies and demonstrated a statistically significant reduction in the density of the superficial vascular plexus in the parafoveal region (standardized difference of means = -0.53, IC 95% [-1.04, -0,02], p = 0.04 and Total effect Z = 2.04, i² = 87%). Conclusion: The studies included in this systematic review demonstrated that there is a reduction in the parameters of retinal vascular density in patients with Parkinson's Disease, compared with the control group, using Optical Coherence Tomography Angiography. The level of evidence from the meta-analysis was impaired by the high heterogeneity of the data and risk of bias. Thus, we suggest the performance of longitudinal studies, in addition to cross-sectional ones, assessment of peripapillary vascularization and the development of a well defined protocol for the use of this technology by different devices, so that greater levels of evidence can assess the reduction in the vascular density of the retina as a biological marker of Parkinson's disease in the near future.