Effects of B12 Deficiency Anemia on Radial Peripapillary and Macular Vessel Density: An Optical Coherence Tomography Angiography (OCTA) Study

Semra Koca; Erhan Bozkurt; Mustafa Dogan; Filiz Yavasoglu; Özgür Erogul; Ayten Kocaman Bulut

doi:10.1055/a-1738-9941

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2023; 240(01): 92-98
DOI: 10.1055/a-1738-9941

Klinische Studie

Effects of B12 Deficiency Anemia on Radial Peripapillary and Macular Vessel Density: An Optical Coherence Tomography Angiography (OCTA) Study

Auswirkungen der B₁₂-Mangelanämie auf die radiale peripapilläre und makuläre Gefäßdichte: eine optische Kohärenztomografiestudie (OCTA-Studie)

Semra Koca

¹Department of Ophthalmology, Kayseri City Education and Research Hospital, Kocasinan/Kayseri, Turkey

,

Erhan Bozkurt

²Department of Internal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey

,

Mustafa Dogan

³Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey

,

Filiz Yavasoglu

⁴Department of Hematology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey

,

Özgür Erogul

³Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey

,

Ayten Kocaman Bulut

⁵Department Augenheilkunde, Medizentrum Eckert MVZ GmbH, Bruchsal, Germany

› Author Affiliations

Abstract

Background To evaluate the macular and optic disc vascular changes in vitamin B12 deficiency anemia.

Methods A total of 24 patients with vitamin B12 deficiency anemia and 24 healthy controls were involved in this study. All participants were evaluated for central macular thickness (CMT), peripapillary retina nerve fiber layer (RNFL) thickness, foveal avascular zone (FAZ) area, macular vessel density (VD) in superficial capillary plexus (SCP) and deep capillary plexus (DCP), choriocapillaris flow area, and optic disc radial peripapillary capillary (RPC) VD using optic coherence tomography (OCT) and optic coherence tomography angiography (OCTA). Metabolic parameters were also noted.

Results Temporal RNFL thickness significantly decreased in the B12 deficiency anemia group (p = 0.04). Choriocapillaris flow area (p = 0.045) and macular vessel density in both SCP (p = 0.022) and DCP (p = 0.018) markedly declined in the study group. Optic disc RPC VD in the B12 deficiency anemia group was lower in all regions compared to that of the control group, but the difference was not statistically significant (p > 0.05). There were significant positive correlations between choriocapillaris flow area, macular VD, vitamin B12, and hemoglobin.

Conclusion Retinal vascular alterations were observed in B12 deficiency anemia, and OCTA may be beneficial in the diagnosis and follow-up of ocular complications in these cases.

Zusammenfassung

Hintergrund Beurteilung der vaskulären Veränderungen der Makula und der Papille bei Vitamin-B₁₂-Mangelanämie.

Methoden In diese Studie wurden insgesamt 24 Patienten mit Vitamin-B₁₂-Mangelanämie und 24 gesunde Kontrollpersonen eingeschlossen. Die zentrale Makuladicke (CMT), die peripapilläre Nervenfaserschicht der Retina (RNFL), der Bereich der fovealen avaskulären Zone (FAZ), die Makulagefäßdichte (VD) im oberflächlichen Kapillarplexus (SCP) und tiefen Kapillarplexus (DCP), die Choriokapillarisflussfläche und Papillen-RPC-VD wurden bei allen Teilnehmern durch optische Kohärenztomografie (OCT) und optische Kohärenztomografieangiografie (OCTA) analysiert. Hierzu wurden auch metabolische Parameter erfasst.

Ergebnisse Die temporale RNFL-Dicke nahm bei der B₁₂-Mangelanämie-Gruppe signifikant ab (p = 0,04). Die Choriokapillarisflussfläche (p = 0,045) und die Makulagefäßdichte sowohl bei SCP (p = 0,022) als auch bei DCP (p = 0,018) nahmen in der Studiengruppe deutlich ab. Die Papillen-RPC-VD bei der B₁₂-Mangelanämie-Gruppe war in allen Regionen niedriger als bei der Kontrollgruppe, jedoch statistisch nicht signifikant (p > 0,05). Es gab signifikante positive Korrelationen zwischen Choriokapillarisflussfläche, Makula-VD und Vitamin B₁₂, Hb.

Schlussfolgerung Bei B₁₂-Mangelanämie sind Gefäßveränderungen in der Retina zu finden. OCTA kann in diesen Fällen zur Diagnose sowie Nachverfolgung der Komplikationen nützlich sein.

Key words

B12 deficiency anemia - macula - optic disc - optical coherence tomography angiography - retina nerve fiber layer

Schlüsselwörter

B₁₂-Mangelanämie - Makula - optische Kohärenztomografieangiografie - Papille - Retina-Nervenfaserschicht

Full Text

References

References
1 Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr 2004; 24: 299-326
2 Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician 2003; 67: 979-986
3 Stover PJ. Physiology of folate and vitamin B12 in health and disease. Nutr Rev 2004; 62: 3-12
4 Babior BM, Bunn HF. Megaloblastic anemias. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. eds. Harrisonʼs principles of internal medicine. 15th ed. New York: McGraw-Hill; 2001: 674-680
5 Akdal G, Yener GG, Ada E. et al. Eye movement disorders in vitamin B12 deficiency: two new cases and a review of the literature. Eur J Neurol 2007; 14: 1170-1172
6 Miller A, Korem M, Almog R. et al. Vitamin B12, demyelination, remyelination and repair in multiple sclerosis. J Neurol Sci 2005; 233: 93-97
7 Amemiya T. The eye and nutrition. Jpn J Ophthalmol 2000; 44: 320
8 Pasol J. Neuro-ophthalmic disease and optical coherence tomography: glaucoma look-alikes. Curr Opin Ophthalmol 2011; 22: 124-132
9 Lu Y, Li Z, Zhang X. et al. Retinal nerve fiber layer structure abnormalities in early Alzheimerʼs disease: evidence in optical coherence tomography. Neurosci Lett 2010; 480: 69-72
10 Moschos MM, Tagaris G, Markopoulos I. et al. Morphologic changes and functional retinal impairment in patients with Parkinson disease without visual loss. Eur J Ophthalmol 2011; 21: 24-29
11 Black MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull 2008; 29 (2 Suppl.): S126-S131
12 Larner AJ. Visual failure caused by vitamin B12 deficiency optic neuropathy. Int J Clin Pract 2004; 58: 977-978
13 Chester EM, Agamanolis DP, Harris JW. et al. Optic atrophy in experimental vitamin B12 deficiency in monkeys. Acta Neurol Scand 1980; 61: 9-26
14 Carraro MC, Rossetti L, Gerli GC. Prevalence of retinopathy in patients with anemia or thrombocytopenia. Eur J Haematol 2001; 67: 238-244
15 Foulds WS. The ocular manifestations of blood diseases. Trans Ophthalmol Soc U K 1963; 83: 345-360
16 Chidlow G, Wood JPM, Casson RJ. Investigations into Hypoxia and Oxidative Stress at the Optic Nerve Head in a Rat Model of Glaucoma. Front Neurosci 2017; 11: 478
17 Ayyildiz T, Dulkadiroglu R, Yilmaz M. et al. Evaluation of macular, retinal nerve fiber layer and choroidal thickness by optical coherence tomography in children and adolescents with vitamin B12 deficiency. Int Ophthalmol 2021; 41: 2399-2404
18 Turkyılmaz K, Oner V, Turkyılmaz AK. et al. Evaluation of peripapillary retinal nerve fiber layer thickness in patients with vitamin B12 deficiency using spectral domain optical coherence tomography. Curr Eye Res 2013; 38: 680-684
19 Ozkasap S, Turkyilmaz K, Dereci S. et al. Assessment of peripapillary retinal nerve fiber layer thickness in children with vitamin B12 deficiency. Childs Nerv Syst 2013; 29: 2281-2286
20 Gupta DS, Shakeel T, Dhawan A. et al. Effect of vitamin B12 deficiency on peripapillary retinal nerve fiber layer. Int J Ophthalmol 2021; 14 (09) 1424-1429
21 Pellegrini F, Prosdocimo G, Papayannis A. et al. Optical coherence tomography angiography findings in deficiency optic neuropathy. Neuroophthalmology 2018; 43: 401-406
22 Icel E, Ucak T. The effects of vitamin B12 deficiency on retina and optic disc vascular density. Int Ophthalmol 2021; 41: 3145-3151
23 Yang J, Su J, Wang J. et al. Hematocrit dependence of flow signal in optical coherence tomography angiography. Biomed Opt Express 2017; 8: 776-789
24 Oliveira C. Toxic-Metabolic and Hereditary Optic Neuropathies. Continuum (Minneap Minn) 2019; 25: 1265-1288
25 Sadun AA. Metabolic optic neuropathies. Semin Ophthalmol 2002; 17: 29-32