Optical Coherence Tomography and Angiography for the Assessment of Retinal Microvasculature in Retinopathy of Prematurity Patients: A Systematic Review and Meta-Analysis Publisher



Mollapour Ballujeh M ; Asghari R ; Abdali P ; Mojmeli A ; Ebne Ali Heydari Y ; Deldar F ; Shokouhfar M ; Darzi A ; Abdol Homayuni M R
Source: Survey of Ophthalmology Published:2026

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 (I²). 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 mm²%, P < 0.05). Laser-treated eyes had greater foveal thickness than regressed (MD: 35.5 µm, P < 0.001) and untreated ROP (MD: 26.6 µm, 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. © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.