Optical coherence tomography measurements in retinopathy of prematurity: A systematic review and meta-analysis

Purpose To systematically evaluate retinal and choroidal structural alterations measured by optical coherence tomography (OCT) in individuals with a history of retinopathy of prematurity (ROP) compared with healthy controls, and to identify sources of heterogeneity across studies. Methods A PROSPERO-registered systematic review (CRD42023422605) was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and EMBASE were searched from inception through July 26, 2023. Human observational studies reporting OCT-derived retinal or choroidal thickness metrics in ROP with healthy controls were included. Random-effects meta-analyses were performed using standardized mean differences (SMD) and weighted mean differences. Meta-regression and subgroup analyses explored heterogeneity. Results Eleven studies (1,019 participants; 351 ROP, 668 controls) were included. Compared with controls, eyes with ROP demonstrated significantly thinner macular ganglion cell–inner plexiform layer (GCIPL) thickness (SMD −1.07; p = 0.002) and thinner superior and temporal perifoveal retina, alongside significantly increased foveal retinal thickness (SMD 1.41; p < 0.0001). No significant difference was observed in subfoveal choroidal thickness. Substantial heterogeneity was present across most outcomes (I 2 frequently >75%). Meta-regression identified younger age at imaging as significantly associated with greater foveal thickening ( p = 0.002). OCT platform and geographic location also contributed to variability. Conclusions Individuals with prior ROP exhibit persistent, layer-specific and region-specific macular alterations consistent with disrupted neurovascular development and foveal hypoplasia. However, substantial methodological heterogeneity limits transportability of thickness-based biomarkers. Standardized, age-aware prospective OCT studies are required before structural metrics can be adopted for clinical risk stratification or longitudinal surveillance.