OCT reveals significant macular GCIPL thinning and foveal thickening in retinopathy of prematurityOCT Scans Reveal Structural Changes in Retinopathy of Prematurity

PurposeTo 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.MethodsA 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.ResultsEleven 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;  = 0.002) and thinner superior and temporal perifoveal retina, alongside significantly increased foveal retinal thickness (SMD 1.41;  < 0.0001). No significant difference was observed in subfoveal choroidal thickness. Substantial heterogeneity was present across most outcomes (I frequently >75%). Meta-regression identified younger age at imaging as significantly associated with greater foveal thickening ( = 0.002). OCT platform and geographic location also contributed to variability.ConclusionsIndividuals 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.