Evaluation of the retinal and choroidal microvasculature in retinitis pigmentosa using OCT-angiography: a meta-analysis.

BACKGROUND

Retinitis pigmentosa (RP) comprises a group of genetically and clinically heterogeneous retinal dystrophies characterized by progressive retinal degeneration, leading to deterioration of vision. Optical coherence tomography angiography (OCTA) enables non-invasive assessment of retinal and choroidal microvasculature and has increasingly been used in the assessment of microvascular changes in PR.

OBJECTIVES

To assess current evidence regarding the retinal and choroidal microvasculature using optical coherence tomography angiography in patients with RP.

DESIGN

Meta-analysis.

DATA SOURCES AND

METHODS

A comprehensive literature search was performed in the PubMed database, including studies published up to July 2025. Eligible journal articles were quality and consistency assessed prior to inclusion. Mean difference (MD) and variances were calculated from reported means and standard deviations in patient and control groups. Heterogeneity was evaluated based on the values of I 2 and p-values. Group mean differences were reported with 95% confidence intervals (CIs) and 95% predicted intervals (PIs).

RESULTS

Nineteen eligible studies were included for this meta-analysis. The foveal perfusion density of RP patients was significantly lower than that of the control group for superficial capillary plexus, MD = -6.09% (95% CI: -9.75, -2.43), and deep capillary plexus, MD = -4.57% (95% CI: -7.22, -1.91). The parafoveal perfusion density of RP patients was significantly lower than that of the control group for superficial capillary plexus, MD = -8.72% (95% CI: -11.71, -5.74) and deep capillary plexus, MD = -6.55% (95% CI: -12.14, -0.96). The foveal avascular zone area of RP patients was significantly increased as compared to that of the control group for superficial capillary plexus, MD = 0.10 mm2 (95% CI: 0.02, 0.17), and deep capillary plexus, MD = 0.12 mm2 (95% CI: 0.02, 0.23). The perfusion density in the choriocapillaris of RP patients was not significantly lower than that of the control group in the foveal region, MD = -1.41% (95% CI: -6.73, 3.91), but was significantly lower in the parafoveal region, MD = -2.44% (95% CI: -3.85, -1.03). Significant heterogeneity was present across studies, resulting in PIs encompassing zero difference for all measures.

CONCLUSION

The findings suggest an association between retinitis pigmentosa and reduced retinal and choroidal microvasculature parameters. However, substantial interstudy heterogeneity and wide PIs limit the certainty and generalizability of the results. Microvascular attenuation is likely occurring secondary to retinal degeneration and may share a similar mechanism to the peripheral large vessel attenuation, which is typically described peripherally in advanced RP.