Retinal and Choroidal Vascular Alterations on Swept-Source Optical Coherence Tomography Angiography in Adults With a History of Retinopathy of Prematurity

Background and Objective: This study aimed to characterize the central retinal and choroidal vasculature in adults with a history of retinopathy of prematurity (ROP). Patients and Methods: In this cross-sectional study, adults with history of ROP were compared to full-term controls using macular 6 × 6-mm and 12 × 12-mm swept-source optical coherence tomography angiography (OCTA) (PLEX Elite 9000). Vessel density (VD) and vessel skeletonized density (VSD) were quantified in the superficial capillary plexus, deep capillary plexus (DCP), and whole retina. Foveal avascular zone (FAZ) metrics, mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were also analyzed. Linear mixed-effects models adjusted for age and nesting estimated group differences for global and sector-level outcomes. A secondary exploratory analysis was conducted to compare treated versus untreated ROP eyes. Results: Twenty-three eyes from 13 adults with ROP and 19 eyes from 15 controls were included. ROP eyes showed significantly lower VD and VSD across all layers on both scan sizes (all P < .05), with largest effects in the DCP. Sector maps revealed widespread deficits that preferentially involved inferior and temporal regions. On 6 × 6-mm scans, FAZ area, circularity, and perimeter were smaller in ROP (all P < .05). On 12 × 12-mm scans, CVI was reduced in ROP ( P = .048), while MCT did not differ. Previously treated ROP eyes had lower VD and VSD compared to untreated ROP eyes (all P < .05). Conclusion: Adults with a history of ROP exhibit persistent retinal microvascular loss and decreased choroidal vascularity. OCTA can be used to assess sub-clinical abnormalities and as a future outcome measure when comparing ROP treatment modalities.