Stage Diagnosis of Hepatitis B Cirrhosis Based on Noninvasive Eye Examination

Abstract

Background: The liver is an important organ of the human body and has the greatest ability to eliminate harmful toxins. Objectives: Hepatitis B cirrhosis is a progressive and life-threatening liver disease, and accurate stage diagnosis is crucial for treatment planning and prognosis prediction. Traditional diagnostic methods for cirrhosis staging often involve invasive procedures or rely on a combination of serological and imaging tests with certain limitations. The main objectives of this study were to comprehensively evaluate the blood flow characteristics in the fundus and to explore the potential of quantifying the stage diagnosis of hepatitis B cirrhosis through non-invasive ophthalmic measurements. By analyzing the blood flow parameters in the retina and choroid, we aimed to establish a new, non-invasive, and convenient method for assessing the severity of hepatitis B cirrhosis. Methods: A total of 20 myopic subjects (40 eyes) were prospectively recruited for this study. All participants provided informed consent, and the study protocol adhered to the tenets of the Declaration of Helsinki. Subjects with other significant systemic diseases (such as diabetes, hypertension with severe complications) or eye diseases that could affect fundus blood flow were excluded. Optical coherence tomography angiography (OCTA) was used as the primary measurement tool. This advanced imaging technique allows for high-resolution, non-invasive visualization of the microvasculature in the eye. The retinal no blood flow zone (FAZ) area was carefully measured, which reflects the integrity and function of the inner retinal capillary network. Additionally, the area of the flow-free perfusion area in the retina was quantified. This parameter can indicate potential ischemic changes in the retinal tissue. Furthermore, the mean choroidal capillary density was measured. The choroid, a vascular layer beneath the retina, plays a crucial role in supplying nutrients and oxygen to the outer retina and photoreceptor cells. Measuring its capillary density can provide valuable information about the overall blood flow status in the posterior segment of the eye. Results: The results demonstrated significant differences in fundus blood flow at almost all levels of the retina and choroid among different stages of hepatitis B cirrhosis. In the superficial retina, there were notable variations in capillary density and perfusion patterns, with more pronounced alterations observed in the advanced stages of cirrhosis. The middle retinal layers also showed distinct changes in blood flow parameters, which correlated well with the progression of liver disease. In the choroid, the mean capillary density decreased gradually as the stage of cirrhosis advanced, indicating compromised blood supply to this important vascular layer. Interestingly, except for the FAZ area in the deep retina, where the statistical significance was on the verge of significance (P = 0.061), all other measured parameters showed significant differences (P < 0.05). The lack of a more significant difference in the deep retinal FAZ area might be due to the relatively stable anatomical structure of this region or the limited sample size of the study, which requires further investigation. Conclusions: Our study clearly showed that fundus blood flow is closely related to the stage diagnosis of hepatitis B cirrhosis. These findings suggest a potential link between the microvascular changes in the eye and the systemic pathophysiological processes occurring in hepatitis B-related liver cirrhosis. Given the non-invasive nature of OCTA and the convenience of eye examinations, we speculated that non-invasive eye examination can be used as a supplementary method for the stage diagnosis of hepatitis B cirrhosis. However, further large-scale, multi-center studies are needed to validate these findings and establish standardized diagnostic criteria based on fundus blood flow parameters for hepatitis B cirrhosis staging.