Post-phacoemulsification Vascular Changes in the Macula and Optic Nerve Using Optical Coherence Tomography Angiography: A Systematic Review

Abstract

Introduction

Age-related cataracts are the leading cause of blindness worldwide, and phacoemulsification is the standard surgical treatment. Optical coherence tomography angiography (OCTA) enables non-invasive assessment of these microvascular changes. However, findings from individual studies remain inconsistent. This systematic review aimed to determine potential vascular changes in the macula and optic nerve using OCTA following phacoemulsification.

Methods

This review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three different databases—Scopus, PubMed and Web of Science—were searched for relevant studies published from 2015 to June 2025. Study quality was assessed using the Study Quality Assessment Tools developed by the National Heart, Lung, and Blood Institute (NHLBI). Among the identified studies, 21 were included in the review. All included studies assessed the changes in the retinal vascular network following phacoemulsification.

Results

The quality of most of the studies was moderate to high. Most studies reported an increase in vascular density in various vascular plexuses, though these changes varied by retinal region, vascular plexus, and follow-up duration. A reduction in the foveal avascular zone (FAZ) was also observed. These changes may be attributed to post-operative inflammation, decreased intraocular pressure (IOP) and increased retinal metabolism.

Conclusions

The results from this systematic review reveal that most included studies reported an increase in vascular density in various plexuses. These changes varied depending on retinal region, specific plexus, and follow-up duration. Additionally, a reduction in the FAZ was commonly observed. Patient-specific factors, such as diabetes and myopia, were associated with variability in vascular response.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-025-01306-9.

Key Summary Points

Why carry out this study?

Age-related cataracts are the leading cause of blindness worldwide, and phacoemulsification is the standard surgical treatment.

Optical coherence tomography angiography (OCTA) enables non-invasive assessment of these microvascular changes.

The aim of this systematic review was to evaluate vascular changes in the macula and optic nerve using OCTA following phacoemulsification.

What was learned from the study?

Most included studies reported an increase in vascular density in various plexuses.

A reduction in the foveal avascular zone (FAZ) was commonly observed.

Patient-specific factors, such as diabetes and myopia, were associated with variability in vascular response.

Introduction

Age-associated cataracts are the leading cause of blindness worldwide, affecting approximately 16 million individuals [1, 2]. The main symptom that affects patients’ quality of life is the gradual decline in visual acuity. Phacoemulsification followed by intraocular lens implantation is the standard treatment for this condition [1]. Although the procedure has become increasingly safe, it has certain complications. While phacoemulsification is performed on the anterior segment of the eye, it has been shown to affect the posterior pole, leading to changes in retinal thickness even after uneventful surgery [2]. These alterations are thought to result from post-operative inflammation, functional hyperaemia, and changes in intraocular pressure (IOP) [3]. Pseudophakic cystic macular oedema is one of the most frequent retinal complications, with an incidence rate of 1.17% [4].

Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality that provides in vivo visualisation of the retinal and choroidal microvasculature without the need for dye injection [5, 6]. Based on the concept of ‘motion contrast’ [5], OCTA detects the movement of red blood cells and compares sequential B-scan signals in the same location, enabling the visualisation of large and small vessels [6, 7]. This technique has demonstrated good repeatability and reproducibility [8].

Numerous studies have investigated microvascular changes in the retina and choroid following phacoemulsification using OCTA. However, the post-operative effects of the treatment remain unclear. Some studies have shown an increase in vessel density in the deep capillary plexus (DCP) [4, 9–12], intermediate capillary plexus (ICP) [11], and superficial capillary plexus (SCP) [4, 10, 12–14]. Conversely, others have reported no change in vessel density following surgery [15]. Furthermore, several studies have documented a reduction in the foveal avascular zone (FAZ), which persists for up to 3 months after surgery [8–10, 13, 14].

Vascular perfusion throughout the retina increases after cataract surgery. This increase is observed at 2 weeks and remains stable for up to 1 year [3]. Phacoemulsification has been associated with increased retinal thickness and flow index in the SCP and DCP, with the greatest increase in the DCP. However, no change has been observed in the outer retina or choroid [16]. Several studies evaluating changes in vessel density in the optic nerve head (ONH) using OCTA following phacoemulsification have reported increased vessel density and a negative correlation between IOP and vessel density at 1 and 4 weeks post-operatively [17]. Post-operatively, an increase in vessel density was observed within the optic nerve head, while it remained unchanged in the peripapillary region [10].

Despite the number of studies analysing changes in the retinal vasculature following cataract surgery, there is no consistency in the results. Changes in vascular density have been reported in different retinal plexuses, as well as a reduction in the FAZ; however, some studies have found no significant changes. This lack of consensus restricts our understanding of how cataract surgery affects the retinal vasculature. To date, no systematic review has been conducted that includes all articles assessing retinal microvascular changes using OCTA after phacoemulsification.

The main objective of this study was to conduct a systematic review to determine the possible vascular changes in the retina and optic nerve using OCTA following phacoemulsification. Additionally, this review aimed to identify patterns, risk factors, and potential underlying mechanisms contributing to the observed changes after cataract surgery, while also carefully examining the risk of bias and certainty of publication in all included studies.

Methods

This systematic review was developed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PRISMA enables the evaluation of the effects of health interventions independent of the study design. It includes a checklist that assists in the reporting of systematic reviews [18]. This study is a systematic review, as it was not possible to perform a meta-analysis due to the heterogeneity of the OCTA devices used and the methodologies applied.

Study Search

An exhaustive literature search was performed between July 2024 and June 2025 using the following databases: PubMed/MEDLINE (72 articles), Scopus (294 articles), and Web of Science (113 articles). The search strategy included terms describing cataract surgery and phacoemulsification (‘phacoemulsification’ OR ‘cataract surgery’ OR ‘cataract extractions’ OR ‘phakectomy’ OR ‘phakectomies’ OR ‘pseudophakic’), the instrument used for examining ocular structures (‘OCTA’ OR ‘OCT-A’ OR ‘OCT angiography’ OR ‘optical coherence tomography angiography’), and assessed variables (‘blood flow density’ OR ‘retinal microcirculation’ OR ‘foveal avascular zone’ OR ‘vessel density’ OR ‘macular hemodynamic’ OR ‘retinal vascularity’ OR ‘retinal vasculature’ OR ‘vascular density’ OR ‘vascular perfusion’ OR ‘retinal vessels’ OR ‘perfusion density’ OR ‘retinal blood flow’ OR ‘capillary vessel density’ OR ‘deep capillary plexus’ OR ‘superficial capillary plexus’ OR ‘nerve’ OR ‘optic nerve head’ OR ‘macula’ OR ‘radial peripapillary capillary plexus’). The search included articles published from 2015 to June 2025. The search strategy employed for each database is provided in the Supplementary Material (Appendix A).

Inclusion Criteria

Studies evaluating changes in retinal microcirculation following uncomplicated phacoemulsification surgery were included. The inclusion criteria were defined as follows: (1) studies involving human participants; (2) case reports; case series; cohort, cross-sectional and case–control studies; (3) randomised clinical trials; and (4) articles published in the last 10 years.

Exclusion Criteria

The exclusion criteria were defined as follows: (1) studies involving children or adolescents; (2) studies that did not use OCTA; (3) articles not available in English; (4) letters, conference abstracts, study protocols, or literary reviews; (5) studies involving additional surgery beyond phacoemulsification; (6) journal not indexed in the Journal Citation Reports (JCR); (7) reported outcomes were irrelevant or ineligible for analysis (no relevant outcome data).

Quality of Articles, Levels of Evidence and Data Extraction

To ensure accurate and appropriate classification of the articles, two authors (RGO and MCSG) independently extracted the data using the Study Quality Assessment Tools developed by the National Heart, Lung, and Blood Institute (NHLBI) [19]. A summary table (Table 1) was created based on the author’s assessments.

Table 1.

Quality appraisal of the included studies

Author (date)	Yes/total
Baldascino et al. (2022)	11/14
Nourinia et al. (2023)	8/9
Jia et al. (2021)	8/9
Karabulut et al. (2019)	7/14
Liu et al. (2021)	10/14
Yu et al. (2018)	7/14
Zhao et al. (2018)	8/9
Baldascino et al. (2023)	9/12
Tarek et al. (2021)	8/12
Zhu et al. (2023)	8/14
Li et al. (2020)	8/12
Curic et al. (2022)	10/14
Gawecki et al. (2022)	11/14
Yao et al. (2023)	9/12
Krizanovic et al. (2021)	8/14
Yang et al. (2022)	9/12
Feng et al. (2021)	9/12
Svjaščenkova et al. (2023)	8/12
Özkan et al. (2022)	8/14
Pilotto et al. (2019)	5/14
Kim et al. (2024)	7/12

This instrument enables the systematic evaluation of article quality by assessing key elements across different study designs, including cohort, case–control, cross-sectional studies and randomised controlled trials.

The assessed elements included the theoretical framework of the study, appropriate methodological design, recruitment details, description and representativeness of the participants, robustness of the research (including control or risk of bias), appropriateness of data analysis (including qualitative analysis, where applicable), control of confounding factors, and clear discussion of the implications of findings.

The quality of the articles was grouped into three levels: low (yes: 0–4), moderate (yes: 5–9), and high (yes: 10–14) for observational and cross-sectional studies; low (yes: 0–3), moderate (yes: 4–7), and high (yes: 8–12) for case–control studies; and low (yes: 0–2), moderate (yes: 4–7), and high (yes: 7–9) for case series studies.

In this systematic review, all included observational, case–control, and cross-sectional studies were of high to moderate quality. Additionally, all case series were of high quality.

Based on this classification, seven articles were determined to be of moderate quality, whereas 14 were classified as high quality.

Table 1 presents the agreed-upon ratings using the Study Quality Assessment Tools.

Ethical Approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Results

Initially, 479 articles were identified. After excluding duplicates, 422 articles were subjected to title and abstract screening by two authors, resulting in the removal of 379 articles. In the case of disagreement regarding article selection, the conflict was resolved by a third author. The full texts of 33 articles were examined, and 12 were excluded based on the exclusion criteria. Ultimately, 21 articles were incorporated into the review. Supplementary Material, Figure S1 shows the PRISMA Flow Chart.

Characteristics of the Studies

Across the 21 included studies, 1,031 patients who underwent cataract surgery were examined for changes in retinal vasculature using OCTA pre-operatively and post-operatively. The mean follow-up among studies was 90 days.

The most frequently analysed variables in the studies were retinal vessel density, the FAZ, and perfusion density. An association was observed between cataract surgery and changes in retinal vasculature.

Retinal vascular density has been evaluated in different retinal plexuses, including the SCP [1–3, 5, 9–15, 20–26], ICP [11, 20, 22], DCP [1, 2, 5, 9–13, 20–24, 26], and whole retina [8].

Six studies analysed changes in the vasculature of the ONH [2, 7, 10, 15, 17, 26].

Of the 13 studies that examined the FAZ [2, 5, 8–10, 12–14, 20, 21, 23, 24, 26], 13 evaluated the area of the FAZ [2, 5, 8–10, 12–14, 20, 21, 23, 24, 26], five analysed the circularity [5, 10, 12, 14, 21], and six assessed the perimeter [2, 5, 12, 14, 21, 23].

Five studies compared the changes in the capillary network between patients with and without diabetes as well as between patients with and without diabetic retinopathy [15, 21, 23, 25, 26]. Two articles compared patients with and without high myopia [1, 24].

Table 2 provides a summary of the characteristics of the included studies, Table 3 presents the main findings from each study, and Table 4 indicates the changes using symbols.

Table 2.

Study characteristics

Author (year)	Design	Conflict of interest	Inclusion criteria	Exclusion criteria	Follow-up	Numbers of eyes and patients	Sex	Age
Baldascino et al. (2022)	RCSS	No	NC; CC; No IOD; IOP ≤ 21 mmHg	IOP ≥ 21 mmHg; PSC; PP OT; IOS; AXL > 26 mm; abnormal intraocular findings; glaucoma; RL; SD; poor OCT images; PostOp complications	1 Wk	23 eyes (23 patients)	NR	75.86 ± 8.85 years
Nourinia et al. (2023)	PCS	No	CS	IntraOp or PostOp complications; previous IOS; uveitis; MP; IVI; HTN; DM; DR; CKD; SSI < 6	3 Mo	50 eyes (50 patients)	M: 21 F: 29	66.9 ± 7.7 years
Jia et al. (2021)	POS	No	Age-related cataracts; Age 60–70 years; AXL ≥ 22 mm and ≤ 24 mm; normal IOP; LOCS-N: 2–3 +	DM; HTN; SVD; IOS; OT; RL; high IOP; glaucoma; RD; PostOp anterior chamber inflammation; CE; SSI < 6; excessive artifacts	4 Wk	107 eyes (107 patients)	M: 45 F: 62	63.2 ± 2.7 years
Karabulut et al. (2019)	POS	No	NR	MP; ONH pathologies; optic neuropathies; IOP ≥ 21 mmHg; AXL ≤ 20 and ≥ 24 mm; CE; massive cataracts; vasoactive agents use; SD; IOS; SSI ≤ 60	4 Wk	24 eyes (24 patients)	M: 20 F:4	65.4 years (60–70 years)
Liu et al. (2021)	PO	No	IOP ≤ 21 mmHg; no severe cataracts; no fixation; no OD; no SD; no previous IOS	NR	3 Mo	58 eyes (47 patients)	M:25 F: 25	66.26 ± 11.92 years
Yu et al. (2018)	POS	No	SSI ≥ 6	Glaucoma; RD; RL	1 Wk	13 eyes (12 patients)	M: 6% F: 94%	71.2 ± 10.7 years
Zhao et al. (2018)	PCS	No	NC; CC; no IOD; IOP ≤ 21 mm Hg; AXL (20.00–25.00 mm)	PSC; PP; OT; IOS; abnormal intraocular findings; poor OCT images; unstable fixation; IntraOp or PostOp complication	3 Mo	32 eyes (32 patients)	M:14 F:18	66.25 ± 8.54 years
Baldascino et al. (2023)	POMC	No	NC; CC; no IOD; IOP ≤ 21 mmHg	IOP ≥ 21 mmHg; PSC; PP; AXL ≥ 26 mm; aberrant intraocular findings; RL; glaucoma; RD; SD; inflammatory or cardiovascular conditions; SSI ≥ 7	1 Mo	130 eyes (65 patients)	M: 35 F: 30	67.8 ± 10.9 years
Tarek et al. (2021)	OCC	No	NR	RD; glaucoma; uveitis; amblyopia; SD; macular oedema; hard exudates; haemorrhages; SSI ≤ 7/10	1 Mo	G A: DM 30 eyes G B: No DM 30 eyes	G A: F: 76.60% G B: F: 73.30%	G A: 57.20 ± 4.09 years G B: 54.50 ± 6.34 years
Zhu Z et al. (2023)	PO	No	Age-related cataract	DM; HTN; RD; glaucoma; ONH pathologies; RL; IOS; lack of cooperation for repeated measurements; SII ≤ 6	3 Mo	34 eyes (27 patients)	M:11 F:16	70.6 ± 14.0 years
Li et al. (2020)	POS	No	Aged > 50 years	Glaucoma; CD; RVD; previous IOS; OT; pre-existing OD affecting vision; SD	3 Mo	G A; (SE) ≤ ‑6.0 D and (AL) ≥ 25 mm 24 eyes (21 patients) G B: SE > ‑6.0 D and AL < 25 mm 31 eyes (23 patients)	G A: 9 M:9 F: 15 G B: M:11 F: 20 f	G A: 65.32 ± 6.01 years G B: 67.66 ± 4.59 years
Curic et al. (2022)	PS	No	Senile cataract; OCTA SSI ≥ 30; AXL 20–25 mm; IOP 10–21 mmHg; BP ≥ 90/60 mmHg and ≤ 140/90 mmHg	DM; CD; PEX; glaucoma; RD that could affect OCT and OCTA measurements; childhood, juvenile and traumatic cataract; IntraOp and /or postOp complications; unregulated HTN	6 Mo	95 eyes (95 patients)	M: 37 F: 58	73 years
Gawecki et al. (2022)	RS	No	Consent to participate in the study; history of uncomplicated CS; No RD; SII ≥ 9/10 for OCTA	CE; PSC; SE ≥ -6D; AXL ≥ 26 mm	1 year	44 eyes (17 patients)	M:10 F: 7	NR
Yao et al. (2023)	POCCS	No	Age ≥ 40 years; SE <  − 6 D; AXL < 26 mm; no OT; no history of IOS; no DME and DR treatment	Glaucoma; uveitis; RD; vitreoretinal interface disorders; RVO; RAO	3 Mo	G A: DM: 22 eyes (22 patients) G B: Control: 22 eyes (22 patients)	G A: M:13 F: 9 G B: M:12 F:10	G A: 65.1 ± 1.68 years G B: 65.1 ± 1.68 years
Krizanovic et al. (2021)	NR	No	Uncomplicated senile cataract; cataract PNS (1, 2, or 3); SII > 30; AXL (20–25 mm); IOP (10–21 mmHg); SYS: (90–140 mmHg); DIA (60–90 mmHg)	CD; PEX; cataract other than uncomplicated senile; glaucoma; AMD; HR; PM; DM; IntraOp and/or PostOp complications; poor SSI	3 Mo	55 eyes (55 patients)	M: 18 F:32	70 (65–76) years
Yang et al. (2022)	OCS	No	NC; CC; no PP; no IOD; IOP < 21 mmHg	Glaucoma; CD; RVD; previous IOS; SD; PM, VM; OCTA SSI < 6 (total score, 10); PostOp complications; high IOP; macular oedema; RD	3–6 Mo	G A: high myopia (AL ≥ 26.5 mm): 20 Patients G B: control (22 < AL ≤ 24.5 mm):18 patients	G A: M:5 F: 15 G B: M: 2 F:16	G A: 56 ± 6.42 years G B: 57.53 ± 8.60 years
Feng et al. (2021)	POS	No	CS (T2DM); IOP (10 mm and 21 mm Hg); AXL (20.0 mm and 26.0 mm)	PDR; CSDME; anti-VEGF; PRP; OT; IOS; glaucoma; uveitis; OCT SSI < 5; severe cataracts; unstable fixation	3 Mo	G A: Diabetics 32 eyes (32 patients) G B: Control 40 eyes (40 patients)	G A: M: 31.25% G B: M: 32.5%	G A: 68.31 ± 9.42 years G B: 71.60 ± 6.85 years
Svjaščenkova et al. (2023)	PLS	No	Age ≥ 18 years; T2DM	OT; MP	3 Mo	G A: DM con DME: 10 eyes G B: DM sin DME: 22 eyes	G A: M:1 F: 9 G B: M: 5 F: 17	G A: 68.00 (63.25–74.50) years G B: 71.00 (64.00–77.00) years
Özkan et al. (2022)	PCSS	No	Age (40–70 years); clear ocular media; adequate pupillary dilation; fixation	DM; HTN; IOS; SSI < 6; SE > 3D; AXL (22–24.5 mm); RD; glaucoma; regular medication; smoking	3 Mo	53 eyes of 53 patients	M: 25 F: 28	62.1 ± 7.2 years
Pilotto et al. (2019)	PCSS	No	Cataract both eyes; SE(− 6 to + 6 D); SSI > 7	DM; HTA; amblyopia; strabismus; anisometropia > 3D; Dif AXL > 1.5 mm; IOS; uveitis; chronic open-angle glaucoma; RD	90 Dys	9 eyes of 9 patients	M: 6 F:3	71 ± 6 years
Kim et al. (2024)	POCCS	No	Visually significant cataract	Age < 18; poor SSI; DME; PDR; IOS; AXL > 26.5 mm; IOD; RD; complicate surgery	6 Mo	G DM NO DR: 60 eyes of 60 patients G DM DR: 23 eyes of 23 patients	G NO DR: M: 25 F: 35 G DR: M: 8 F: 15	G NO RD: 69.5 ± 8.8 G RD: 69.6 ± 8.7

POS prospective observational study, RCSS retrospective cross-sectional study, PCSS prospective cross-sectional study, PCS prospective case series, PO prospective observational, PLS prospective longitudinal study, OCS observational cohort study, POCCS prospective observational case–control study, G group, RS retrospective study, POMC prospective observational monocentric control-group, OCC observational case–control. NR no reported, IOP intraocular pressure, Mo months, M male, F female, Dy day, Wk weeks, SSI signal strength index, NPDR non-proliferative diabetic retinopathy, DR diabetic retinopathy, SE spherical equivalent, AXL axial length, PNS pentacam nucleus staging, PDR proliferative diabetic retinopathy, CSDME clinically significant diabetic macular oedema, PRP panretinal photocoagulation, DM diabetes mellitus, DME diabetic macula oedema, T2DM type 2 diabetes mellitus, PP posterior polar cataract, PSC posterior subcapsular cataract, HTN hypertension, IVI intravitreal injection, RD retinal diseases, SD systemic disease, RL retinal laser, NC nuclear cataract, CC cortical cataract, OT ocular trauma, IntraOp intraoperative, PostOp post-operative CKD chronic kidney disease, SVD systemic vascular diseases, ONH optic nerve head, OD ocular diseases, IOD intraocular diseases, CD corneal diseases, PEX pseudoexfoliative syndrome, IOS intraocular surgery, SYS systolic blood pressure DIA diastolic blood pressure, MP macular pathologies, CE corneal oedema, BP blood pressure, RVD retinal vasculature diseases, RVO retinal vein occlusion, RAO retinal artery occlusion, AMD age-related macular degeneration, HR hypertensive retinopathy, PM pathological myopia, VM vascular maculopathy, CS cataract surgery.

Table 3.

Results regarding retinal and optic nerve vascular change

Author (year)	OCTA	Intraocular lens	OCTA measurement
				PreOP		PostOp 1 Wk	p value
Baldascino et al. (2022)	Cirrus HD-OCT 5000® (Carl Zeiss Meditec, Inc., Dublin, CA, USA) Zoom: 3 × 3	Alcon AcrySof® single-piece SA60WT, Alcon Laboratories Inc.	FAZ Mean ± SD	A (mm2)	0.27 ± 0.12	0.24 ± 0.11	0.008*
				Perim (mm)	2.31 ± 0.54	2.17 ± 0.58	0.057
				AI	0.59 ± 0.05	0.62 ± 0.09	0.49
			Vd SCP Mean ± SD (mm−1)	C	8.20 ± 3.30	11.24 ± 4.84	0.001*
				Inner	16.04 ± 3.62	19.02 ± 2.64	< 0.001*
				Full	15.14 ± 3.41	19.02 ± 2.64	< 0.001*
			PD SCP Mean ± SD (%)	C	14.95 ± 6.05	19.98 ± 8.93	0.003*
				Inner	29.97 ± 6.18	35.59 ± 4.17	0.001*
				Full	28.3 ± 5.73	33.74 ± 4.13	< 0.001*

				PreOp			PostOp 1 Mo	p value (Pre–1 Mo)	PostOp 3 Mo	p value (Pre-3 Mo)
Nourinia et al. (2023)	RTVue XR Avanti® (Optovue, Inc, Fremont CA, USA) Zoom: 6 × 6	NR	FAZ Mean ± SD (mm2)	0.36 ± 0.13			0.32 ± 0.12	< 0.001*	0.31 ± 0.13	< 0.001*
			VD Mean ± SD (%)	SCP	F	13.9 ± 6.87	18.44 ± 7.88	< 0.001*	16.07 ± 7.32	< 0.001*
					PaF	43.75 ± 4.71	45.73 ± 4.93	0.009*	44.27 ± 4.71	0.514
					Wh	43.23 ± 4.36	44.95 ± 4.52	0.003*	43.12 ± 4.69	0.902
				DCP	F	28.22 ± 8.3	34.55 ± 8.9	< 0.001*	28.16 ± 8.82	0.933
					PaF	48.71 ± 6.74	55.26 ± 6.66	< 0.001*	48.73 ± 7.55	0.981
					Wh	39.92 ± 6.22	47.9 ± 8.49	< 0.001*	42.86 ± 6.5	0.002*

			PreOp			PostOp 1 Dy	p value (Pre–1 Dy)	PostOp 1 Wk	p value (Pre–1 Wk)	PostOp 4 Wk	p value (Pre-4 Wk)
Jia et al. (2021)	RTVue-XR ® (Optovue, Inc., Fremont, CA, USA) Zoom: 6 × 6	NR	FAZ Mean ± SD	A (mm2)	0.35 ± 0.14	0.36 ± 0.13	> 0.05	0.35 ± 0.14	> 0.05	0.33 ± 0.14	> 0.05
				Perim (mm)	2.31 ± 0.48	2.32 ± 0.49	> 0.05	2.28 ± 0.53	> 0.05	2.21 ± 0.48	> 0.05
				AI	1.14 ± 0.02	1.12 ± 0.04	> 0.05	1.11 ± 0.15	> 0.05	1.11 ± 0.04	> 0.05
			MVD Mean ± SD (%)	SCP	44.70 ± 3.98	44.54 ± 3.96	> 0.05	48.04 ± 3.08	< 0.01*	48.21 ± 3.61	< 0.01*
				DCP	43.75 ± 4.95	43.19 ± 5.40	> 0.05	47.92 ± 4.02	< 0.05*	47.74 ± 4.04	< 0.05*

				PreOp		PostOp 1 Wk	p value (Pre-1 Wk)	PostOp 4 Wk	p value (Pre-4 Wk)
Karabulut et al. (2019)	RTVue-XR Avanti® (Optovue, Inc., Fremont, CA, USA) Zoom: 4.5*4.5	Alcon AcrySof® single-piece SA60WT, Alcon Laboratories Inc.	VD ONH Mean ± SD (%)	Total Disc	47.8 ± 1.8	48.2 ± 1.7	0.377	49.4 ± 1.6	0.002*
				PeriP	49.5 ± 1.9	50.1 ± 1.9	0.544	51.8 ± 2.4	0.045
				Inside disc	49.3 ± 5.3	50.2 ± 5.6	0.300	53.0 ± 5.4	< 0.001*

				PreOp			Post 1 Wk	Post 1 Mo	Post 3 Mo	p value (Pre–3 Mo)
Liu et al. (2021)	RTVue-XR Avanti® (Optovue, Inc., Fremont, CA, USA) Zoom: 6 × 6	NR	FAZ Mean ± SD (mm2)	0.73 ± 0.91			NR	0.42 ± 0.23	0.34 ± 0.17	< 0.05*
			VD Mean ± SD (%)	SCP	PaF	43.3 ± 7.8	41.3 ± 6.2	42.8 ± 5.6	42.2 ± 5.7	0.643
					PeriF	47.2 ± 8.6	45.3 ± 5.6	46.0 ± 4.8	45.4 ± 4.6	0.565
				DCP	PaF	43.2 ± 13.2	45.5 ± 9.9	48.9 ± 8.2	46.4 ± 9.6	0.130
					PeriF	37.2 ± 9.9	40.1 ± 9.3	43.9 ± 8.2 (p < 0.01) vs pre**	40.8 ± 8.2	0.012*

				PreOp			PostOp 1 Wk	p value (Pre–Post)
Yu et al. (2018)	PLEX® Elite 9000 (Carl Zeiss Meditec, Inc, Dublin, CA) Zoom: 3 × 3	NR	FAZ Mean ± SD	A (mm2)	0.231 ± 0.82		0.215 ± 0.97	0.441
				P (mm)	2.31 ± 0.781		1.94 ± 0.443	0.061
				AI	0.589 ± 1.68		0.678 ± 0.86	0.171
			Vd Mean ± SD (mm-1)	SCP	Inner ring	18.9 ± 1.49	20.1 ± 1.75	0.047*
					Inner 3 mm	18.0 ± 1.37	19.2 ± 1.66	0.035*
					3 × 3 mm	18.1 ± 1.32	19.2 ± 1.67	0.53
				DCP	Inner ring	9.55 ± 3.32	12.7 ± 2.74	0.004*
					Inner 3 mm	8.53 ± 2.87	11.3 ± 2.44	0.003*
					3 × 3 mm	9.12 ± 2.92	12.00 ± 2.59	0.008*
			PD Mean ± SD (%)	SCP	Inner ring	0.391 ± 0.032	0.424 ± 0.020	0.004*
					Inner 3 mm	0.374 ± 0.031	0.405 ± 0.018	0.003*
					3 × 3 mm	0.380 ± 0.031	0.410 ± 0.210	0.004*
				DCP	Inner ring	0.197 ± 0.060	0.267 ± 0.061	0.001*
					Inner 3 mm	0.176 ± 0.052	0.239 ± 0.055	0.001*
					3 × 3 mm	0.187 ± 0.051	0.250 ± 0.051	0.002*

				PreOP		PostOp 1 Wk	PostOp 1 Mo	PostOp 3 Mo	p value
Zhao et al. (2018)	RTVue-XR Avanti® (Optovue, Inc., Fremont, CA, USA) Zoom: 6 × 6	Tecnis® ZCB00, Abbott Medical Optics, Inc.	FAZ Mean ± SD (mm2)	0.569 ± 0.112		0.487 ± 0.128	0.441 ± 0.126	0.417 ± 0.112	< 0.0001*
			VD Mean ± SD (%)	ParaF	61.59 ± 7.75	63.12 ± 7.46	66.76 ± 6.70	65.12 ± 9.45	0.281*
				PeriF	62.88 ± 8.22	66.65 ± 6.83	66.76 ± 7.76	64.65 ± 9.37	0.0126*

				PreOp			PostOp 1 Wk	p value (Pre-1 Wk)	PostOp 1 Mo	p value (Pre-1 Mo)
Baldascino et al. (2023)	Solix full-range OCT® (Optovue Inc., Freemont, CA, USA) Zoom: M: 6.4 × 6.4 ONH: 4.5 × 4.5	Alcon AcrySof® single-piece SA60WT, Alcon Laboratories Inc.	FAZ Mean ± SD	A (mm2)		0.38 ± 0.22	0.26 ± 0.01	0.01*	0.27 ± 0.11	0.005*
				Perim (mm)		2.53 ± 0.83	2.06 ± 0.48	0.003*	2.04 ± 0.45	0.008*
				FD (%)		40.0 ± 6.8	41.65 ± 0. 6.5	0.78	44.9 ± 5.7	0.0016*
			VD Mean ± SD (%)	SCP	Sup	43.0 ± 3.6	43.2 ± 4.6	0.78	45.5 ± 5.3	0.0003*
					Inf	42.9 ± 4.9	43.6 ± 4.6	0.58	45.8 ± 5.6	0.001*
					Wh	43.0 ± 4.2	43.4 ± 4.6	0.85	45.6 ± 5.4	0.0001*
				DCP	Sup	36.6 ± 7.5	37.3 ± 7.4	0.48	42.9 ± 9.7	0.0005*
					Inf	38.2 ± 8.3	38.2 ± 10.0	0.95	44.6 ± 8.6	0.003*
					Wh	37.3 ± 7.4	37.4 ± 11.1	0.92	43.7 ± 9.1	0.0002*
				ONH	Wh	49.6 ± 2.7	51.4 ± 4.6	0.001*	49.3 ± 4.0	0.95
					RPC	45.6 ± 4.2	48.5 ± 6.2	0.001*	44.8 ± 4.6	0.24

					PreOp			PostOp 1Mo		p value
Tarek et al. (2021)	RTVue XR Avanti® (AngioVue; Optovue Inc., Fremont, CA, USA) Zoom: M: 6 × 6 ONH: 4.5 × 4.5	Acrysof®, Alcon, USA	VD Mean ± SD (%)	SCP	Diabetic group
					C	13.37 ± 6.45		13.70 ± 11.47		0.082
					Sup PaF	44.63 ± 10.32		44.23 ± 7.40		0.338
					Inf PaF	42.57 ± 10.96		42.87 ± 6.74		0.555
					Nas PaF	41.23 ± 8.55		41.83 ± 7.09		0.647
					Temp PaF	43.47 ± 8.84		40.73 ± 9.27		0.257
					Sup PeriF	42.33 ± 8.55		43.37 ± 7.72		0.170
					Inf PeriF	42.47 ± 8.33		44.07 ± 8.00		0.789
					Nas PeriF	45.70 ± 6.80		46.5 ± 7.54		0.002*
					Temp PeriF	38.07 ± 8.02		37.47 ± 7.98		0.259
				RPC	52.8 ± 4.47			52.0 ± 4.59		0.204
			VD Mean ± SD (%)	SCP	Non-diabetic group
					C		9.27 ± 7.37	11.2 ± 6.40	0.740
					Sup PaF		44.53 ± 12.65	46.10 ± 11.27	0.260
					Inf PaF		42.83 ± 12.35	44.00 ± 10.81	0.4236
					Nas PaF		37.07 ± 7.29	41.90 ± 10.36	0.047*
					Temp PaF		39.97 ± 7.95	43.77 ± 8.16	0.234
					Sup PeriF		47.13 ± 8.69	46.50 ± 8.78	0.595
					Inf PeriF		47.37 ± 9.64	49.33 ± 10.80	0.810
					Nas PeriF		49.97 ± 7.42	50.63 ± 8.52	0.197
					Temp PeriF		39.63 ± 8.36	40.11 ± 7.11	0.136
				RPC	50.9 ± 4.89			52.1 ± 4.89	0.090

					PreOp		PostOp 1Wk	p value
Zhu et al. (2023)	RTVue XR Avanti® (Optovue Inc, Fremont, CA, USA) Zoom: 4.5 × 4.5	NR	VD Mean ± SD (%)	RPC	Total disc	48.1 ± 3.0	48.0 ± 2.3	0.826
					Inside disc	47.5 ± 5.3	50.2 ± 3.7	0.007*
					PeriP	50.3 ± 3.9	49.4 ± 2.6	0.111
					Sup-hemi	50.5 ± 4.1	49.8 ± 2.7	0.143
					Inf-hemi	50.1 ± 3.8	49.4 ± 2.7	0.183
					Inf quadrant	52.8 ± 4.7	51.0 ± 4.2	0.019*
					Sup quadrant	51.1 ± 4.2	49.2 ± 3.6	< 0.001*
					Nas quadrant	45.7 ± 4.7	45.2 ± 3.13	0.471
					Temp quadrant	53.2 ± 4.6	53.3 ± 2.7	0.935
				All	Total disc	54.13 ± 2.79	54.60 ± 2.12	0.226
					Inside disc	57.87 ± 4.30	60.47 ± 3.10	0.001*
					PeriP	56.01 ± 3.62	56.05 ± 2.57	0.913
					Sup-hemi	56.52 ± 4.00	56.49 ± 2.65	0.935
					Inf-hemi	55.45 ± 3.65	55.58 ± 2.73	0.771
				Large	Total disc	5.95 ± 0.59	6.54 ± 0.49	< 0.001*
					Inside disc	10.41 ± 1.80	10.11 ± 1.50	0.337
					PeriP	5.63 ± 0.77	6.47 ± 0.72	< 0.001*
					Sup-hemi	5.94 ± 0.84	6.66 ± 0.88	< 0.001*
					Inf-hemi	5.44 ± 1.16	6.27 ± 1.00	0.001

					PreOp		PostOp 1 Dy	PostOp 1 Wk	PostOp 1 Mo	PostOp 3 Mo	p value
Li et al. (2020)	RTVue XR Avanti® (Optovue Inc, Fremont, CA, USA) Zoom: 3 × 3	NR	VD Mean ± SD (%)	SCP	GA	46.22 ± 0.98	46.34 ± 1.01	48.29 ± 1.13	48.59 ± 0.82	45.79 ± 0.65	0.008*
					GB	46.30 ± 0.73	50.33 ± 0.78	51.84 ± 0.72	51.84 ± 0.72	50.91 ± 0.68	< 0.001*
				DCP	GA	51.93 ± 1.21	54.56 ± 1.24	55.62 ± 1.15	57.69 ± 0.65	51.46 ± 1.25	< 0001*
					GB	54.14 ± 1.07	57.31 ± 0.60	57.67 ± 1.04	59.22 ± 0.71	57.61 ± 0.84	0.001

				PreOp	PostOp 1 Wk	PostOp1Mo		PostOp 3 Mo	PostOp 6 Mo	p value
Curic et al. (2022)	HRA + OCT Spectralis® (Heidelberg Engineering, Heidelberg, Germany) Zoom: 2.9 × 2.9	AMO Tecnis® PCB00, Johnson & Johnson Vision, Jacksonville, FL, USA	FAZ Mean ± rng (mm2)	0.326 (0.2539–0.4279)	0.2632 (0.1984–0.3446)	0.2539 (0.1993–0.3362)		0.2566 (0.1925–0.3198)	0.2554 (0.1815–0.3177)	< 0.001*
			VA % Change	1 Wk			p-value
				SCP	11.29%		< 0.001*
				ICP	12.82%		< 0.001*
				DCP	12.75%		< 0.001*
			VPA % Change	SCP	10.83%		< 0.001*
				ICP	12.81%		< 0.001*
				DCP	12.75%		< 0.001*

			PreOp				PostOp 2 Wk		PostOp 3 Mo		PostOp 1 year
Gaweki et al. (2022)	Zeiss AngioPlex SD-OCT® (Carl Zeiss Meditec AG, Jena, Germany) Zoom: 3 × 3	Monofocal intraocular lens	Vd SCP Mean ± SD (mm−1)	C	7.22 ± 5.29	0.071	9.45 ± 4.77	< 0.001*	9.21 ± 4.61	0.218	8.40 ± 4.68	0.418
				Full	14.35 ± 4.05	0.969	18.03 ± 2.66	< 0.001*	18.31 ± 3.38	0.007*	17.84 ± 3.25	0.209
			PD SCP Mean ± SD (%)	C	12.40 ± 9.34	0.038*	17.06 ± 8.83	0.003*	16.59 ± 8.33	0.107	16.78 ± 8.53	0.240
				Full	26.58 ± 8.16	0.556	33.55 ± 4.69	< 0.001*	33.97 ± 5.63	0.025*	33.43 ± 5.37	0.142

				PreOp			PostOp 1 Wk	PostOp 1 Mo	PostOp 3 Mo	p value
Yao et al. (2023)	Triton DRI-OCT® (Topcon, Inc., Tokyo, Japan) Zoom: 3 × 3	NR	VD SCP Mean ± SD (%)	DR group	F	18.65 ± 2.05	18.23 ± 1.72	18.77 ± 1.64	18.48 ± 1.78	0.216
					PaF	46.63 ± 1.74	47.18 ± 1.35	49.11 ± 1.69	48.67 ± 1.38	< 0.001*
				Control group	F	19.2 ± 2.6	18.6 ± 2.9	19.38 ± 3.01	19.29 ± 2.9	0.213
					PaF	48.28 ± 2	48.58 ± 1.86	49.44 ± 1.69	49.05 ± 1.45	0.027

					PreOp	PostOp 1 Wk	PostOp 1 Mo	PostOp 3 Mo	p value
Krizanovic et al. (2021)	HRA + OCT Spectralis® (Heidelberg Engineering, Heidelberg, Germany) Zoom: 2.9 × 2.9 mm	Zeiss® CT Lucia 611PY or AMO Tecnis® PCB00	VA Mean ± rng (mm2)	SCP	4.4132 (3.8255–4.9965)	4.9826 (4.6831–5.2155)	5.0491 (4.7088–5.3848)	5.0094 (4.7490–5.4082)	< 0.001*
				DCP	4.2319 (3.4769–4.8241)	4.9539 (4.4996–5.2425)	4.9380 (4.5294–5.3485)	4.9121 (4.5870–5.4160)	< 0.001*
				ICP	52.6315 (44.8284–58.0264	58.4357 (55.8038–62.1985)	58.7958 (54.0681–61.9713)	60.0813 (56.1073–63.3031)	< 0.001*
				NFLVP	1.7746 (1.3408–2.4250)	2.3389 (1.7994–2.7072)	2.4731 (2.0283–3.0603)	2.4584 (1.9830–2.9862)	< 0.001*
			VPA Mean ± rng (%)	SCP	52.6630 (45.6480–59.7126)	59.4532 (55.8881–62.2341)	60.2560 (56.1915–64.2580)	59.7772 (56.6644–64.6154)	< 0.001*
				DCP	50.5055 (41.6312–57.5592)	59.1286 (53.7127–62.5724)	58.9327 (54.1117–63.8239)	58.6169 (54.7285–64.6397)	< 0.001*
				ICP	52.6315 (44.8284–58.0264)	58.4357 (55.8038–62.1985)	58.7958 (54.0681–61.9713	60.0813 (56.1073–63.3031)	< 0.001*
				NFLVP	21.1911 (16.0203–28.9405)	27.9786 (21.4717–32.3195)	29.5066 (24.2454–36.5190)	29.3376 (23.6625–35.6347)	< 0.001*

					PreOp			PostOp 1 Dy	PostOp 1 Wk	PostOp 1 Mo	PostOp 3–6 Mo	p value
Yang et al. (2022)	RTVue XR Avanti® (software version 2.0, Optovue, Fremont, CA, USA) Zoom: 6 × 6	NR	GA	VD Mean ± SD (%)	SCP	PaF	43.06 ± 3.76	51.32 ± 4.54	51.32 ± 4.54	50.56 ± 3.76	46.77 ± 4.64	0.009*
						PeriF	43.45 ± 3.19	50.18 ± 2.95	48.21 ± 3.73	49.70 ± 2.93	47.16 ± 3.85	< 0.001*
					DCP	PaF	46.98 ± 3.56	51.36 ± 3.97	50.24 ± 3.20	50.83 ± 4.27	50.85 ± 4.17	0.002*
						PeriF	38.85 ± 2.39	46.73 ± 4.49	44.16 ± 4.52	43.97 ± 4.30	43.62 ± 4.30	< 0.001*
				FAZ Mean ± SD (mm2)	0.321 ± 0.096			0.275 ± 0.093	0.281 ± 0.106	0.281 ± 0.105	0.290 ± 0.100	< 0.001*
			GB	VD Mean ± SD (%)	SCP	PaF	47.90 ± 4.02	52.13 ± 4.32	51.83 ± 4.32	52.98 ± 2.61	49.98 ± 4.15	0.040*
						PeriF	46.68 ± 3.03	50.84 ± 3.41	49.70 ± 3.54	50.64 ± 2.62	48.61 ± 3.49	0.011*
					DCP	PaF	50.93 ± 2.49	52.86 ± 3.37	53.19 ± 3.41	53.19 ± 3.41	52.77 ± 3.71	0.024*
						PeriF	43.94 ± 4.47	48.60 ± 4.90	48.62 ± 5.47	49.01 ± 5.37	47.89 ± 5.47	0.007*
				FAZ Mean ± SD (mm2)	0.275 ± 0.072			0.256 ± 0.069	0.265 ± 0.066	0.262 ± 0.068	0.259 ± 0.073	< 0.001*

			PreOp				PostOp 1 Dy	PostOp 1 Wk	PostOp 1 Mo	PostOp 3 Mo
Feng et al. (2021)	RTVue-XR Avanti® (version 2017.1, OptoVue, Inc.,USA) Zoom: 3 × 3	Tecnis® ZCB00, Abbott Medical Optics, Inc., USA	GA	VD Mean ± SD (%)	SCP	38.47 ± 4.37	40.09 ± 5.59	42.67 ± 3.22	42.11 ± 3.40	44.96 ± 4.52*
					DCP	46.68 ± 5.42	48.48 ± 3.81	49.13 ± 3.57	47.04 ± 3.50	48.00 ± 2.37
				FAZ Mean ± SD	A (mm2)	0.287 ± 0.120	0.253 ± 0.094	0.282 ± 0.153	0.290 ± 0.129	0.289 ± 0.146
					Perim (mm)	2.263 ± 0.527	2.060 ± 0.535	2.145 ± 0.580	2.220 ± 0.468	2.242 ± 0.565
					AI	1.20 ± 0.11	1.16 ± 0.10	1.17 ± 0.05	1.18 ± 0.11	1.15 ± 0.06
			GB	DV Mean ± SD (%)	SCP	39.05 ± 6.45	38.59 ± 6.59	41.70 ± 7.33	41.61 ± 7.07	40.39 ± 6.36
					DCP	46.17 ± 3.74	47.75 ± 4.02	48.68 ± 4.37	46.96 ± 2.87	48.10 ± 2.75
				FAZ Mean ± SD	A (mm2)	0.389 ± 0.120	0.343 ± 0.128	0.374 ± 0.142	0.363 ± 0.136	0.366 ± 0.124
					Perim (mm)	2.254 ± 0.477	2.377 ± 0.463	2.448 ± 0.514	2.430 ± 0.543	2.443 ± 0.480
					AI	1.17 ± 0.08	1.17 ± 0.06	1.14 ± 0.04	1.15 ± 0.09	1.15 ± 0.06

				PreOp				PostOp 1 Mo	PostOp 3 Mo	p value
Svjaščenkova et al. (2023)	Optovue RTVue XR 100 Avanti® Edition. Software Version 2015.0, Optovue, Inc., USA) Zoom: FAZ: 3 × 3 VD: 6 × 6	NR	FAZ Mean ± rng	GA	A (mm2)	0.35 (0.30–0.40)		0.45 (0.39–0.55)	0.42 (0.29–0.50)	< 0.01*
					Perim (mm)	2.40 (2.29–2.30)		2.83 (2.61–3.50)	2.73 (2.35–3.00)	< 0.01*
				GB	A (mm2)	0.28 (0.23–0.36)		0.25 (0.18–0.34)	0.25 (0.20–0.34)	0.16
					Perim (mm)	2.16 (1.94–2.47)		2.16 (1.94–2.47)	2.04 (1.85–2.39)	0.01*
			VD Mean ± rng (%)	GA	SCP	PaF	38. 5 (36.3–43.85)	39.6 (32.42–43.02)	43.55 (35.33–49.08)	0.42
						PeriF	38.60 (36.60–40.45)	39.15 (36.93–45.35)	42.65 (38.55–47.58)	0.07
					DCP	PaF	43.60 (36.28–47.38)	42.35 (40.43–50.65)	43.70 (39.75–47.50)	0.87
						PeriF	34.25 (32.30–39.00)	37.50 (36.40–43.25)	40.10 (36.60–46.25)	0.16
				GB	SCP	PaF	42.00 (39.60–45.20)	44.45 (38.02–47.88)	43.30 (40.60–47.60)	0.91
						PeriF	42.70 (38.15–57.65)	42.60(39.30–47.20)	43.70 (41.80–47.20)	0.99
					DCP	PaF	48.90 (41.00–51.90)	48.70 (45.63–54.20)	51.00 (47.73–54.23)	0.14
						PeriF	40.00 (34.28–46.35)	42.10 (37.80–47.95)	44.70 (37.20–49.00)	< 0.01*

				PreOp			PostOp 1 Wk	PostOp 1 Mo	PostOp 3 Mo	p value
Özkan et al. (2022)	Optovue RTVue-XR Avanti® (Optovue Inc., Fremont, CA, USA) Zoom: M: 3 × 3 ONH: 4.5 × 4.5	NR	FAZ Mean ± SD	A (mm2)		0.31 ± 0.10	0.30 ± 0.10	0.29 ± 0.10	0.29 ± 0.10	0.001*
				AI		1.14 ± 0.03	1.15 ± 0.03	1.15 ± 0.03	1.15 ± 0.04	0.078
			VD Mean ± SD (%)	SCP	F	13.2 ± 5.2	15.2 ± 5.0	15.1 ± 5.3	16.0 ± 5.3	0,001*
					PaF	46.3 ± 4.7	48.9 ± 3.4	48.5 ± 3.1	50.2 ± 2.7	0,001*
				DCP	F	30.3 ± 6.3	31.7 ± 6.2	31.0 ± 6.3	32.0 ± 6.3	0,001*
					PaF	52.2 ± 4.3	53.3 ± 3.9	53.1 ± 4.0	53.4 ± 3.3	0.049*
			ONH Mean ± SD (%)	PPCVD		51.9 ± 3.4	51.3 ± 3.4	51.4 ± 3.6	51.3 ± 3.2	0.168
				Wh image		48.3 ± 3.2	48.7 ± 2.9	48.6 ± 3.2	49.2 ± 2.9	0.054
				Inside disc		45.9 ± 5.0	47.7 ± 4.7	47.5 ± 4.2	49.2 ± 4.5	0.001*

					PreOp	PostOp 1 Dy	PostOp 7 Dys	PostOp 30 Dys	PostOp 90 Dys	p value
Pilotto et al. (2019)	Nidek RS-3000 Advance® (Nidek, Gamagori, Japan) Zoom: M: 3 × 3	NR	VAD Mean ± SD	SCP	0.1435 ± 0.0254	0.1425 ± 0.0550	0.1543 ± 0.0324	0.1567 ± 0.0293	0.1521 ± 0.0302	0.5709
				ICP	0.2970 ± 0.0352	0.3340 ± 0.0172	0.3234 ± 0.0176	0.3191 ± 0.0195	0.3209 ± 0.0246	0.0030*
				DCP	0.3117 ± 0.0334	0.3688 ± 0.0209	0.3486 ± 0.0175	0.3409 ± 0.022	0.3359 ± 0.0326	0.0002*
			VLF Mean ± SD	SCP	0.0213 ± 0.0040	0.0236 ± 0.0056	0.0227 ± 0.0058	0.0229 ± 0.0052	0.0228 ± 0.0057	0.5199
				ICP	0.0469 ± 0.0062	0.0553 ± 0.0040	0.0511 ± 0.0030	0.0498 ± 0.0035	0.0520 ± 0.0048	0.0010*
				DCP	0.0509 ± 0.0063	0.0625 ± 0.0049	0.0570 ± 0.0039	0.0549 ± 0.0035	0.0564 ± 0.0056	0.0003*
			VDI Mean ± SD	SCP	6.76 ± 0.33	6.74 ± 0.43	6.86 ± 0.39	6.90 ± 0.37	6.75 ± 0.48	0.7495
				ICP	6.34 ± 0.22	6.05 ± 0.20	6.33 ± 0.16	6.41 ± 0.19	6.18 ± 0.14	0.0026*
				DCP	6.14 ± 0.16	5.91 ± 0.18	6.12 ± 0.19	6.21 ± 0.18	5.96 ± 0.12	0.0034*

						PreOp		PostOp 1 Mo	PostOp 6Mo
Kim et al. (2024)	DRI OCT Triton® (Topcon, Tokyo, Japan) Zoom: M: 4.5 × 4.5 ONH: 3 × 3	Tecnis® ZCB00, Abbott Medical Optics, Santa Ana, CA, USA	FAZ Mean ± SD (mm2)	No DR		0.41 ± 0.13*		0.39 ± 0.11*	0.38 ± 0.11*
				DR		0.33 ± 0.12		0.32 ± 0.11	0.30 ± 0.12
			VD Mean ± SD (%)	No DR	SCP	PaF	30.1 ± 3.0	31.1 ± 3.7	31.0 ± 3.5
						PeriF	31.3 ± 2.6	32.3 ± 3.2	32.2 ± 3.3
					DCP	PaF	33.7 ± 2.0	34.3 ± 1.7	34.2 ± 2.1
						PeriF	33.2 ± 2.4	34.0 ± 1.9	33.8 ± 1.9
					RPC	34.4 ± 2.3*		34.9 ± 2.1*	35.6 ± 2.3*
				DR	SCP	PaF	29.6 ± 4.3	30.6 ± 3.6	30.6 ± 3.5
						PeriF	31.5 ± 4.0	32.1 ± 3.4	31.8 ± 3.1
					DCP	PaF	34.2 ± 1.7	34.0 ± 2.2	33.8 ± 2.0
						PeriF	33.9 ± 1.6	34.0 ± 2.1	33.6 ± 1.4
					RCP	33.0 ± 3.5		34.7 ± 2.4	34.0 ± 2.3

FAZ foveal avascular zone, A area, Perim perimeter, AI acircularity index, PostOp post-operative, PreOp pre-operative, Wk week, Dy day, Mo month, VD vascular density, Vd vessel density, PD perfusion density, SCP superficial capillary plexus, NR none reported, ICP intermediate capillary plexus, DCP deep capillary plexus, C central, F fovea, PaF parafovea, PeriF perifovea, Sup superior, Inf inferior, Nas nasal, Temp temporal, Wh whole, MVD macular vascular density, ONH optic nerve head, PeriP peripapillary, FD flow density, RPC radial peripapillary capillary, GA group A, GB group B, VA vessel area, VPA vessel percentage area, DR diabetic retinopathy, NFLVP nerve fibre layer vascular plexus, Rng range, PPCVD peripapillary capillary vessel density, VAD vessel area density, VLF vessel length fraction, VDI VESSEL density index, SD standard deviation

*p < 0.05

Table 4.

Change diagram

Article	Changes
Özkan et al. (2022)	FAZ A (mm2) ↓; FAZ AI =; VD SCP F (%) ↑; VD DCP F (%) ↑; VD SCP PaF (%) ↑; VD DCP PaF (%) ↑; PPCVD ONH (%) =; Wh image ONH (%) =; Inside disc ONH (%) ↑
Feng et al. (2021)	GA: VD SCP (%) ↑; VD DCP (%) =; FAZ A (mm2) =; FAZ Perim (mm) =; FAZ AI = GB: VD SCP (%) =; VD DCP (%) =; FAZ A (mm2) =; FAZ Perim (mm) =; FAZ AI =
Li et al. (2020)	GA: VD SCP (%) ↓; VD DCP (%) ↓ GB: VD SCP (%) ↑; VD DCP (%) =
Svjaščenkova et al. (2023)	GA: FAZ A (mm2) ↑; FAZ Perim (mm) ↑; VD SCP PARAF (%) =; VD SCP PERIF (%) =; VD DCP PARAF (%) =; VD DCP PERIF (%) = GB: FAZ A (mm2) =; FAZ Perim (mm) ↓; VD SCP PARAF (%) =; VD SCP PERIF (%) =; VD DCP PARAF (%) =; VD DCP PERIF (%) ↑
Nourinia et al. (2023)	FAZ A (mm2) ↓; VD SCP F (%) ↑; VD SCP PaF (%) ↑1Mo = 3Mo; VD SCP Wh (%) ↑1Mo = 3Mo; VD DCP F (%) ↑1Mo = 3Mo; VD DCP PaF (%) ↑1Mo = 3Mo; VD DCP Wh (%) ↑1Mo
Jia et al. (2021)	FAZ A (mm2) =; FAZ Perim (mm) =; FAZ AI =; MVD SCP (%) ↑; MVD DCP (%) ↑
Liu et al. (2021)	FAZ A (mm2) ↓; VD SCP PaF (%): =; VD SCP PeriF (%): =; VD DCP PaF (%): =; VD DCP PeriF (%): ↑
Zhao et al. (2018)	FAZ A (mm2) ↓; VD PaF (%) ↑; VD PeriF (%) ↑
Tarek et al. (2021)	GA: VD SCP C (%) =; VD SCP Sup PaF (%) =; VD SCP Inf PaF (%) =; VD SCP Nas PaF (%) =; VD SCP Temp PaF (%) =; VD SCP Sup PeriF (%) =; VD SCP Inf PeriF (%) =; VD SCP Nas PeriF (%) ↑; VD SCP Temp PeriF (%) =; VD RPC (%) = GB: VD SCP C (%) =; VD SCP Sup PaF (%) =; VD SCP Inf PaF (%) =; VD SCP Nas PaF (%) ↑; VD SCP Temp PaF (%) =; VD SCP Sup PeriF (%) =; VD SCP Inf PeriF (%) =; VD SCP Nas PeriF (%) =; VD SCP Temp PeriF (%) =; VD RPC (%) =
Yang et al. (2022)	GA: FAZ A (mm2) ↓; VD SCP PaF (%) ↑; VD SCP PeriF (%) ↑; VD DCP PaF (%) ↑; VD DCP PeriF (%) ↑ GB: FAZ A (mm2) ↓; VD SCP PaF (%) ↑; VD SCP PeriF (%) ↑; VD DCP PaF (%) ↑; VD DCP PeriF (%) ↑
Karabulut et al. (2019)	VD ONH Total Disc (%) ↑; VD ONH PeriP (%) =; VD ONH Inside disc (%) ↑
Zhu et al. (2023)	VD RPC Total disc (%) =; VD RPC Inside disc (%) ↑; VD RPC PeriP (%) =; VD RPC Sup-hemi (%) =; VD RPC Inf-hemi (%) =; VD RPC Inf quadrant (%) ↓; VD RPC Sup quadrant (%) ↓; VD RPC Nas quadrant (%) =; VD RPC Temp quadrant (%) =; VD All total disc (%) =; VD All Inside disc (%) ↑; VD All PeriP (%) =; VD All Sup-hemi (%) =; VD All Inf-hemi (%) =; VD Large Total Disc (%) ↑; VD Large Inside disc (%) ↑; VD Large PeriP (%) ↑; VD Large Sup-hemi (%) ↑; VD Large Perip (%) ↑; VD Large Inf-hemi (%) ↑
Baldascino et al. (2022)	FAZ A (mm2) ↓; FAZ Perim (mm) =; FAZ AI =; Vd SCP C (mm-1) ↑; Vd SCP Inner (mm-1) ↑; Vd SCP Full (mm-1) ↑; PD SCP C (%) ↑; PD SCP Inner (%) ↑; PD SCP Full (%) ↑
Gawecki et al. (2022)	Vd SCP C (mm-1) ↑; Vd SCP Full (mm-1) ↑; PD SCP C (%) ↑; PD SCP Full (%) ↑
Yu et al. (2018)	FAZ A (mm2) =; FAZ Perim (mm) =; FAZ AI =; Vd SCP Inner ring (mm-1) ↑; Vd SCP Inner 3mm (mm-1) ↑; Vd SCP 3 × 3 (mm-1) =; Vd DCP Inner ring (mm-1) ↑; Vd DCP Inner 3mm mm-1) ↑; Vd DCP 3 × 3 (mm-1) ↑; PD SCP Inner ring (%) ↑; PD SCP Inner 3 mm (%) ↑; PD SCP 3 × 3mm (%) ↑; PD DCP Inner ring (%) ↑; PD DCP Inner 3mm (%) ↑; PD DCP 3 × 3 mm (%) ↑
Baldascino et al. (2023)	FAZ A (mm2) ↓; FAZ Perim (mm) ↓; FD% FAZ ↑; VD SCP Sup (%) ↑; VD SCP Inf (%) ↑; VD SCP Wh (%) ↑; VD DCP Sup (%) ↑; VD DCP Inf (%) ↑; VD DCP Wh (%) ↑; VD ONH Wh (%) ↑Wk =1Mo; VD ONH RCP (%) ↑Wk =1Mo
Curic et al. (2022)	FAZ A (mm2) ↓; VPA SCP (%) ↑; VPA ICP (%) ↑; VPA DCP (%) ↑
Krizanovic et al. (2021)	VPA SCP (%) ↑; VPA ICP (%) ↑; VPA DCP (%) ↑; VPA NFLVP (%) ↑
Yao et al. (2023)	DR Group: VD SCP F (%) =; VD SCP PaF (%) ↑ No DR Group: VD SCP F (%) =; VD SCP PaF (%) =
Kim et al. (2024)	DR Group: FAZ A (mm2) =; VD SCP PaF (%) =; VD SCP PeriF (%) =; VD DCP PaF (%) =; VD DCP PeriF (%) =; VD RCP = No DR Group: FAZ A (mm2) ↓; VD SCP PaF (%) =; VD SCP PeriF (%) =; VD DCP PaF (%) =; VD DCP PeriF (%) =; VD RCP: ↑
Pilotto et al. (2019)	VAD SCP =; VAD ICP ↑; VAD DCP ↑; VLF SCP =; VLF ICP ↑; VLF DCP ↑; VDI SCP =; VDI ICP ↓; VDI DCP ↓

FAZ foveal avascular zone, A area, Perim perimeter, AI acircularity index, Wk week, Mo month, VD Vascular density, Vd vessel density, PD perfusion density, SCP superficial capillary plexus, ICP intermediate capillary plexus, DCP deep capillary plexus, C central, F fovea, PaF parafovea, PeriF perifovea, Sup superior, Inf inferior, Nas nasal, Temp temporal, Wh whole, MVD macular vascular density, ONH optic nerve head, PeriP peripapillary, FD flow density, RPC radial peripapillary capillary, GA group A, GB group B, VPA vessel percentage area, DR diabetic retinopathy, NFLVP nerve fibre layer vascular plexus, PPCVD peripapillary capillary vessel density, VAD vessel area density, VLF vessel length fraction, VDI vessel density index

Discussion

OCTA has revolutionised the study of the effects of ocular surgery on the retinal vasculature [3]. This non-invasive imaging technique allows for real-time visualisation of the capillary network and FAZ. By capturing specific images at different depths, OCTA enables observations of the SCP, ICP, and DCP [27].

In this systematic review, changes in the vascular density were observed in the SCP and DCP. A reduction in the FAZ was also noted. With regard to the optic nerve head, an increase in vascular density was reported. These changes appear in the first 3 months after phacoemulsification.

In addition, patients with diabetes and high myopia showed differences in retinal microvasculature compared to healthy individuals.

The following sections provide a detailed synthesis of the individual study findings, along with potential pathophysiological mechanisms underlying these observations.

Vascular Density

In the included studies, vascular density was analysed at different segmentation levels—SCP, ICP, and DCP—with the macula being divided into three areas—fovea, parafovea, and perifovea.

It is important to note that the studies used different OCTA devices. The variability demonstrated in the quantitative measurements obtained from different instruments makes it impossible to compare the results across the various OCTA systems [27]. For this reason, a specific evaluation of the vascular changes was conducted according to the OCTA device and magnification used.

Upon analysing the studies that used the OCTA Optovue RTVue-XR Avanti, a general trend toward an increase in vascular density was observed. In healthy subjects analysed with a 3 × 3 mm scan area, the following findings were reported. An increase in vascular density of the SCP at the fovea and parafovea regions was observed within 1 week and remained elevated up to 3 months [1, 10]. A significant increase in the vascular density of the DCP was also reported [10]. However, not all studies reported changes in the DCP [1, 21] or the SCP [21].

Using the same OCTA device but with a larger scan area—6 × 6 mm—a significant increase in vascular density of the SCP was observed in the foveal [12, 13], parafoveal, and perifoveal [24] regions, with follow-up periods ranging from 1 month [12] to 3 months [12, 24]. Tarek et al. [15] reported an increase limited to the nasal parafoveal region after 1 month. In DCP, an increase in vascular density was observed at 1 week in the foveal [12, 13], parafoveal [13], perifoveal [24], and whole-retina regions [13]. This increase remained stable up to 1 month [12, 13, 24]. At 3 months, vascular density in the foveal and parafoveal regions returned to preoperative values [13]; however, in the whole-retina and perifoveal regions, the increase remained statistically significant compared with preoperative values [13, 24]. Zhao et al. [8] observed an increase in vascular density, but this increase was noted across the whole retina, from the inner limiting membrane to the retinal pigment epithelium, with a 3-month follow-up. In contrast, Liu et al. [9] found no significant changes in vascular density in the SCP—parafoveal and perifoveal regions—or in the DCP—parafoveal region—with values remaining stable throughout the follow-up period.

In studies conducted using Zeiss equipment, an increase was described in both vessel density and perfusion density. A significant increase in vessel density was reported in central and total retinal measurements as early as the first post-operative week [3, 5, 14] and persisting up to 1 year of follow-up [3]. Similarly, Yu et al. confirmed this trend in the DCP at 1 week. Perfusion density exhibited a pattern comparable to that of vessel density, with parallel increases observed in the same capillary regions [3, 5, 14].

In studies using HRA + OCT Spectralis^®, a progressive increase in vascular density was observed in the SCP, ICP, and DCP between 1 week and 3 months of follow-up [20, 22].

In contrast, studies using Triton DRI-OCT^® in healthy subjects found no significant changes in vascular density in the foveal, parafovea, or perifoveal region in either the SCP or the DCP [25, 26].

In turn, Baldascino et al. [2], using the Solix Full-Range OCT^®, reported an increase in vascular density in both the superficial and deep plexuses, distributed across the superior, inferior, and total retinal regions during a 1-month period.

Finally, with the Nidek RS-3000 Advance^®, an increase in vascular area density (VAD) was observed in the intermediate and deep plexuses, as well as in vascular length density (VLF), while superficial plexus density remained unchanged throughout the 3-month follow-up [11].

FAZ

A decrease in the FAZ was observed following phacoemulsification. This decrease remained stable over 3 months in several studies using RTVue-XR Avanti^® [8–10, 13, 24]. In contrast, other studies reported no change in the FAZ [12, 21].

This decrease was also observed with Cirrus HD-OCT 5000^® over 1 week [14], Solix Full-Range OCT^® over a 1-month period [2], with HRA + OCT Spectralis^® and DRI OCT Triton^® at 6 months [19, 26]. No change in the FAZ was reported using PLEX^® Elite 9000 [5].

Regarding the circularity index of the FAZ, no significant changes were observed in several studies [5, 10, 12, 14, 21]. A decrease in FAZ perimeter was observed in one study [2], whereas other studies reported no such change [5, 12, 14, 21].

ONH Vessel Density

Karabulut et al. [17] found an increase in vascular density inside the disc at 4 weeks post-operatively. Supporting Karabulut’s findings, other authors also observed an increase inside the disc at 3-month follow-up [7, 10]. Baldascino et al. [2] described an increase in whole-disc perfusion and radial peripapillary capillary (RPC) density 1 week following surgery, leading to a return to reference values at 30 days post-operatively. This increase was also observed in another study but over a period of 6 months [26], while yet another did not observe any changes [15]. However, some studies did not find any change in peripapillary vascular density [7, 17].

Characteristics Affecting Vascular Capillarity

Diabetes

Various systemic conditions can influence retinal vascularisation. Tarek et al. [15] compared changes in vessel density of the SCP plexus in patients with and without diabetes at 1 month after phacoemulsification. A significant increase was observed in the vessel density in the perifoveal nasal area in patients with diabetes and in the parafoveal nasal area in patients without diabetes. Feng et al. [21] and Yao et al. [25] observed an increase in vessel density in the SCP in patients with diabetes, whereas no such variation was recorded in patients without diabetes. In patients with diabetic retinopathy, an increase was observed in the vessel density of the DCP, accompanied by an expansion of the FAZ area and perimeter. In contrast, patients without diabetic retinopathy experienced a non-significant decrease in the perimeter and area of the FAZ [23]. Kim et al. [26] found a significant reduction in the area of the FAZ in the SCP in patients without diabetic retinopathy, but no significant changes were observed in patients with diabetic retinopathy. Additionally, they reported no significant post-operative changes in parafoveal or perifoveal vessel density in the SCP or DCP for patient with or without diabetic retinopathy.

Tarek et al. [15] detected a non-significant increase in the vessel density of the RPC in patients without diabetes and a non-significant decrease in patients with diabetes. In addition, Kim et al. [26] described an increase in the vessel density of the RPC in patients without diabetes, whereas the changes in patients with diabetic retinopathy were not significant.

Myopia

Several studies have compared changes in vessel density after phacoemulsification in patients with high and low myopia. A reduction in vessel density was detected in the SCP and DCP of patients with high myopia at 3 months. In contrast, an increase in vessel density was observed in the SCP in patients without high myopia [1].

Yang et al. [24] reported an increase in vessel density in the SCP and DCP in patients with and without high myopia.

Mechanisms Involved in Post-operative Vascular Changes

A few studies have analysed changes in the retinal and ONH vascular network following phacoemulsification and proposed several mechanisms to explain these changes. First, an increase in vascular density could be due to a post-operative inflammatory response, which peaks in the first few days following surgery and progressively decreases during the following 2–3 weeks [3]. Inflammation has proangiogenic effects through various mediators, such as vascular endothelial growth factor (VEGF), angiotensin II, metalloproteinases, and different cytokines. These inflammatory mediators diffuse from the anterior chamber, leading to disruption of the inner blood–retinal barrier. The increase in inflammation following cataract surgery can cause or worsen several conditions, such as cystoid macular oedema, progression of diabetic retinopathy, or diabetic macular oedema [24]. The study by Nourinia et al. [13] corroborates this hypothesis, as the increase in vascular density was transient and returned to baseline levels after 3 months. In diabetic patients, in addition to the aforementioned inflammatory effects, preexisting microvascular dysfunction—characterised by pericyte loss, basement membrane thickening, and increased endothelial permeability—may amplify the inflammatory response and hinder post-operative vascular recovery [26]. Second, an increase in vascular density may be correlated with a decrease in IOP following phacoemulsification [3]. Numerous studies have demonstrated that alterations in IOP affect ocular haemodynamics. Several studies have reported a decrease in IOP following cataract surgery [2]. Although the mechanism is not entirely clear, this reduction may be attributed to indirect factors that facilitate aqueous humour outflow. The improvement in drainage through the trabecular meshwork may result from the increased anterior chamber depth and the release of prostaglandin F2α. Another possible explanation is related to the implantation of the intraocular lens, which increases mechanical tension in the zonular region, thereby reducing the resistance to aqueous humour outflow by expanding the trabecular meshwork space [2]. For example, in the study by Baldascino et al. [2], the reduction in IOP coincided with an increase in peripapillary vascular density. Similarly, a negative correlation between IOP and vascular density within the optic disc was observed [17]. A comparable finding was reported in the macular area: Yang’s study demonstrated a 19% reduction in IOP 3–6 months after phacoemulsification, suggesting that the increase in macular blood flow may be related to the decrease in IOP [24]. Third, functional hyperaemia, a consequence of increased exposure to blue light, may stimulate retinal metabolism, thereby increasing oxygen and glucose demand. This metabolic demand triggers the release of vasoactive mediators that induce vasodilation and hyperaemia [3].

Another mechanism that may influence the variability in the results is high myopia. The variability observed between myopic and non-myopic patients may be attributed to several adverse factors associated with high myopia—such as increased axial length (AL), thinner retina and choroid, reduced retinal nerve fibre layer (RNFL) thickness, and decreased vascular diameter—which can affect the macular vascular system. Retinal vessels in patients with high myopia may be less able to tolerate prolonged intraoperative IOP fluctuations, ultimately leading to insufficient autoregulation and inadequate perfusion of the superficial retinal vessels after surgery. Moreover, a negative correlation between axial length and vascular density has been demonstrated [1].

In the interpretation of post-operative OCTA results, the inherent test–retest and inter-visit variability of each platform should be considered. Previous studies have shown that, although quantitative OCTA results obtained using different devices are not directly comparable, measurements performed with the same device demonstrate good reproducibility [27]. Nevertheless, variations attributable to platform-specific variability may occur and may influence the magnitude of the observed changes. However, consistent changes reported across multiple studies, devices, retinal regions, and follow-up intervals are more likely to represent true biological alterations rather than variations related to the measurement process.

Clinical Implications

The findings of this literature review provide relevant information about the changes in retinal and optic nerve vasculature following phacoemulsification using OCTA. The observed increase in vascular density and decrease in the FAZ after the surgery suggest that this procedure may transiently alter retinal haemodynamics through inflammatory and mechanical mechanisms. Since ocular circulation can reflect the onset and progression of various ocular diseases, such as glaucoma or diabetic retinopathy, understanding the changes in the quantitative parameters obtained through OCTA could help assess the safety of the surgery and anticipate possible complications, especially in patients with risk factors [7].

Study Limitations

To the best of our knowledge, this is among the first studies to comprehensively analyse published research on retinal and optic nerve vascular changes after phacoemulsification using OCTA in healthy subjects, providing an updated synthesis of current evidence. However, this study has limitations. The main one is the variability observed in the quantitative OCTA measurements among different commercially available devices. This is due to the algorithms used by each system, the segmentation of the vascular plexuses, and the variability in measurement magnification. Therefore, valid comparisons should only be made within the same device [27]. In addition, the studies included in this review have relatively short follow-up periods, with most of them limited to around 3 months. It would be valuable to include studies with a longer follow-up period. In most of the selected studies, image quality prior to cataract surgery was considered, generally following manufacturer-recommended criteria and excluding scans with artefacts or insufficient signal quality [2, 3, 5, 7, 8, 10–15, 17, 20–22, 24, 26]. However, not all studies explicitly reported the signal strength index (SSI) or equivalent quantitative image quality metrics [1, 9, 22, 25]. Nevertheless, it has been shown that manufacturer-recommended signal quality thresholds are not always sufficient, as low-quality scans may still be included and could affect the quantitative values obtained through OCTA, representing an additional limitation of the present study.

Conclusion

This systematic review has shown that OCTA is a valuable tool for assessing vascular changes in the retina and optic nerve following phacoemulsification. Most included studies reported an increase in vascular density in SCP and DCP. These changes varied depending on retinal region, specific plexus, and follow-up duration. Additionally, a reduction in the FAZ was commonly observed. These effects appear within the first 3 months post-phacoemulsification. Patient-specific factors, such as diabetes and myopia, were associated with variability in vascular response. The mechanisms underlying these changes likely include post-operative inflammation, decreased IOP and increased retinal metabolism.

Overall, OCTA provides an effective non-invasive method for monitoring retinal microcirculation. Future research should focus on the standardisation of OCTA protocols, the need for long-term prospective studies to assess vascular changes over time, and the exploration of the relationship between OCTA changes and functional visual outcomes.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contributions

Raquel García-Oliver and María Carmen Sanchez-González were responsible for conducting the review, writing and reporting the protocol. They also developed the search strategy, selected the potentially eligible studies and reviewed the data. Raquel García-Oliver interpreted the results and prepared the tables. Manuel Caro-Magdaleno participated in the selection and analysis of data and provided feedback on the report.

Funding

This study and the journal’s Rapid Service Fee were funded by Instituto de Salud Carlos III (ISCIII) through the project RD 24/0007/0035 and co-funded by the European Union. The authors independently wrote and prepared this manuscript, and the funding bodies had no role in its design, analysis, interpretation, or writing.

Data Availability

All data supporting the findings of this review are contained within the manuscript. Tables 2, 3 and 4 provide the extracted information for each included study, including study design, sample size, OCTA device, scan area, follow-up period, and main outcomes. No additional datasets were generated or analysed.

Declarations

Conflict of Interest

Raquel García-Oliver, María Carmen Sánchez-González and Manuel Caro-Magdaleno declare that they have no competing interests.

Ethical Approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.