• Xianliang Qiu, Xian Wang, Peipei Hong, Min Liu, Qing Wen, and Qiu Chen.
• School of Clinical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine.
• Medicine (Baltimore). 2020 Jun 12; 99 (24): e20562.

BackgroundDiabetic retinopathy (DR) remains the most common microvascular complication of diabetes; both its high prevalence and associated high risk of vision loss lead it to the major global health burden. Despite significant research efforts, there still remains much of the underlying pathology not fully understand. In the past studies, inner retinal blood flow disturbances are widely assessed as a potential biomarker of DR. However, the results have been variable and even contradictory. Improved methods to figure out the metabolic disturbances associated with DR are essential. Some research showed that both vascular endothelial growth factor-A and blood oxygen saturation are higher in DR patients and correlated with disease severity. Therefore, we decided to conduct a systematic review and meta-analysis to find out the connection of them and provide robust evidence on the mechanism underlying this connection to help us better understand the pathophysiology behind the hypoxic retina and find better ways to treat DR.MethodsThis study will be conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will do electronic searches from PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database, CNKI, and VIP database. Two reviewers will screen all the references independently and any disagreement will be solved by the third involvement. All data will be extracted by 2 independent reviewers according to a standardized data extraction sheet. Based on the type of studies, 2 reviewers will independently use different scales to assess the risk of bias. Any disagreements and conflicts will be resolved by discussing it with a third reviewer. We will conduct a random-effects meta-analysis. Individual and pooled odds ratios/relative risks and associated 95% confidence intervals will be calculated as well as between-study heterogeneity. The potential for publication bias will also be evaluated. If possible, we will explore reasons for potential between-study heterogeneity.ResultsThis study is a protocol for systematic review and meta-analysis without results. Associated data analysis will be carried out after the protocol.ConclusionThe protocol aims to guide a meta-analysis whose purpose is investigating the association between retinal blood oxygen saturation and vascular endothelial growth factors in patients with early DR and trying to find out the mechanism that the changing of retinal oxygen saturation in patients with DR.Inplasy Registration NumberINPLASY202040161.

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