Optical coherence tomography and angiography for the assessment of retinal microvasculature in retinopathy of prematurity patients: A systematic review and meta-analysis

Abstract

We quantitatively compare optical coherence tomography (OCT) and OCT angiogropahy (OCTA) parameters of retinal microvascular structure and thickness between term-born infants, preterm infants without retinopathy of prematurity (ROP), and ROP subgroups (laser-treated, anti-vascular endothelial growth factor (VEGF)-treated, spontaneously regressed, and untreated) through a systematic review and meta-analysis. Following PRISMA guidelines, PubMed, Scopus, and Web of Science were searched from inception to November, 2025, for English-language studies using OCTA in ROP patients with control groups. Data on parameters including vascular density (VD) in superficial/deep capillary plexuses (SCP/DCP), foveal thickness, whole retina thickness, and foveal avascular zone (FAZ) were extracted for term-born infants, preterm infants without ROP, and ROP subgroups (untreated, spontaneously regressed, laser-treated, and anti-VEGF-treated). Random-effects meta-analysis in R software computed pooled mean differences (MD) with 95 confidence intervals and heterogeneity (I(2)). From 298 records, 31 studies were included. Term infants showed significantly lower foveal SCP VD than laser-treated (MD: -9.29, P < 0.001), bevacizumab (MD: -9.09, P < 0.001), and regressed ROP (MD: -7.78, P < 0.001) groups. Similar patterns emerged for foveal DCP VD (MDs: -7 to -8, P < 0.001). Parafoveal SCP VD was higher in term vs. treated groups (MDs: 3-4, P < 0.001). FAZ was larger in term infants (MDs: 0.09-0.18 mm(2), P < 0.05). Laser-treated eyes had greater foveal thickness than regressed (MD: 35.5 microm, P < 0.001) and untreated ROP (MD: 26.6 microm, P = 0.004). No significant differences in whole retina thickness or whole SCP VD. ROP induces persistent microvascular deviations, particularly elevated foveal VD and reduced FAZ, beyond clinical regression, with treatment-specific effects. OCTA enables precise long-term monitoring to stratify visual risk in ROP.