Homocysteine in retinal artery occlusive disease: A meta-analysis of cohort studies

Abstract

Few studies have reported the relationship between retinal artery occlusion (RAO) and plasma homocysteine (Hcy) levels. Our goal was to evaluate the association between the plasma Hcy level and the risk of RAO disease. Several databases were searched for all published studies that involved Hcy and RAO. Six studies evaluated hyperhomocysteinemia (hHcy) in retinal artery occlusion patients and controls; the incidence of hHcy in patients with RAO was higher than the control and the pooled odds ratio (OR) was 6.64 (95% confidence interval (CI): 3.42, 12.89). Subgroup analyses showed that the ORs were 4.77 (95% CI: 2.69, 8.46) in Western countries, 22.19 (95% CI: 2.46, 200.37) in Asian countries, 9.70 (95% CI: 4.43, 21.20) in the age matched group, 11.41 (95% CI: 3.32, 39.18) in the sex matched group, 9.70 (95% CI: 4.37, 21.53) in the healthy control group, and 6.82 (95% CI: 4.19, 11.10) in the sample size >30. The mean plasma Hcy level from 5 case-control studies was higher than controls, and the weighted mean difference (WMD) was 6.54 (95% CI: 2.79, 10.29). Retinal artery occlusion is associated with elevated plasma Hcy levels. Our study results suggest that hHcy is probably an independent risk factor for RAO.

Figure 1

Flow chart for article selection. Flow chart shows literature search for case-control studies of RAO in relation to Hcy.

Figure 2

Forest plot of ORs for hHcy and RAO (a), and WMDs for hcy and RAO (b). The blue square is the OR value, the green square is the WMD value,the black diamond is the 95% CI value. The last black square is the pooled OR or WMD.

Figure 3

Forest plot of the subgroup analysis of ORs for hHcy and RAO. The geographical region (a), the characteristic of control healthy state (b), age matching (c), sex matching (d), and the sample size (e) The blue square is the OR value, the black diamond is the 95% CI.

Figure 4

Funnel Plot detailing publication bias in the studies reporting the impact of hHcy on RAO (a), and mean levels of Hcy on RAO (b). The X axis is the ORs value, the Y axis is the log ORs value in a. The X axis is the WMDs value of Hcy, the Y axis is the WMDs standard error value in b. The cycles indicate the value of each study.