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      Retinal microvasculature features in patients with migraine: a systematic review and meta-analysis

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          Abstract

          Background

          Migraine is a central nervous system disorder involving neuronal and vascular factors. The brain has a close anatomical relationship with retinal vessels and similar regulatory processes, and the retinal vascular system is the only in vivo vessel that can be directly visualized, while optical coherence tomography angiography (OCTA) is an advanced retinal vascular imaging technique. In this study, OCTA was used to study the retinal vascular density (VD) and foveal avascular zone (FAZ) in migraine patients, which provided a theoretical basis for its use as a candidate for rapid and non-invasive diagnosis of migraine.

          Methods

          Published studies comparing retinal microvascular profiles between migraine patients and healthy controls were obtained by a comprehensive search of electronic databases. Nine studies were finally included, including 775 eyes (migraine group: 444 eyes, control group: 331 eyes). Pooled effect sizes were presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager software (version 5.30).

          Results

          The combined results revealed that the superficial and deep macular whole enface VD (MWEVD) (superficial VD: SMD = −0.30, P = 0.0001; deep VD: SMD = −0.61, P = 0.02), superficial foveal VD (FVD) (SMD = −0.42, P = 0.03), deep parafoveal VD (PFVD) (SMD = −0.31, P = 0.002), and peripapillary VD (PVD) (SMD = −0.49, P = 0.002) were significantly reduced in migraine patients compared with healthy people. However, there was a significant increase in the area of the FAZ in migraine patients (SMD = 0.56, P < 0.0001).

          Conclusion

          Migraine patients are prone to retinal microcirculation disorders, such as decreased blood vessel density and increased avascular area in the fovea. This provides a theoretical basis for OCTA as a candidate for rapid, non-invasive diagnosis of migraine.

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          Most cited references77

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

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              Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range

              Background In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of the trials, however, reported the study using the median, the minimum and maximum values, and/or the first and third quartiles. Hence, in order to combine results, one may have to estimate the sample mean and standard deviation for such trials. Methods In this paper, we propose to improve the existing literature in several directions. First, we show that the sample standard deviation estimation in Hozo et al.’s method (BMC Med Res Methodol 5:13, 2005) has some serious limitations and is always less satisfactory in practice. Inspired by this, we propose a new estimation method by incorporating the sample size. Second, we systematically study the sample mean and standard deviation estimation problem under several other interesting settings where the interquartile range is also available for the trials. Results We demonstrate the performance of the proposed methods through simulation studies for the three frequently encountered scenarios, respectively. For the first two scenarios, our method greatly improves existing methods and provides a nearly unbiased estimate of the true sample standard deviation for normal data and a slightly biased estimate for skewed data. For the third scenario, our method still performs very well for both normal data and skewed data. Furthermore, we compare the estimators of the sample mean and standard deviation under all three scenarios and present some suggestions on which scenario is preferred in real-world applications. Conclusions In this paper, we discuss different approximation methods in the estimation of the sample mean and standard deviation and propose some new estimation methods to improve the existing literature. We conclude our work with a summary table (an Excel spread sheet including all formulas) that serves as a comprehensive guidance for performing meta-analysis in different situations. Electronic supplementary material The online version of this article (doi:10.1186/1471-2288-14-135) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                15 September 2023
                2023
                : 14
                : 1187559
                Affiliations
                [1] 1Affiliated Eye Hospital of Nanchang University, Jiangxi Clinical Research Center of Ophthalmic Disease, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang , Jiangxi, China
                [2] 2Department of Orthopaedics, The Fourth Medical Center of Chinese PLA General Hospital , Beijing, China
                [3] 3Medical School of Chinese PLA , Beijing, China
                [4] 4Department of Ophthalmology, Huangshi Central Hospital, Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi , Hubei, China
                Author notes

                Edited by: Gianluca Coppola, Sapienza University of Rome, Italy

                Reviewed by: Nizhuan Wang, ShanghaiTech University, China; Francesco Casillo, Sapienza University of Rome, Italy

                *Correspondence: Xu Zhang xuzhang19@ 123456163.com

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fneur.2023.1187559
                10540451
                37780703
                0a3adfa3-4d1c-4706-a893-1e4c0d3537a9
                Copyright © 2023 Pang, Cao, Zhang, Hu, Wang, Nie, Jin, Chen and Zhang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 16 March 2023
                : 25 August 2023
                Page count
                Figures: 9, Tables: 2, Equations: 0, References: 77, Pages: 16, Words: 8950
                Funding
                Funded by: National Natural Science Foundation of China, doi 10.13039/501100001809;
                This study was supported by the National Natural Science Foundation of China (Grant No. 81860170) and the Innovation Fund Designated for Graduate Students of Jiangxi Province (YC2022-B043).
                Categories
                Neurology
                Review
                Custom metadata
                Neurological Biomarkers

                Neurology
                migraine,optical coherence tomography angiography,retinal microvasculature,vascular density,meta-analysis

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