Retinal and choroidal changes in patients with acute leukemia: a systematic review of OCT/OCT-A findings

Introduction Ocular involvement is a clinically relevant but often underrecognized manifestation in acute leukemia (AL). This review consolidates retinal and choroidal alterations in AL patients using optical coherence tomography (OCT) and OCT angiography (OCT-A). Methods A literature search was conducted in EMBASE, Web of Science, and PubMed/MEDLINE on April 14, 2025. The search was subsequently updated on September 3, 2026. A total of 635 eyes were investigated. Results Patients with AL exhibited reduced parafoveal superficial capillary plexus (SCP) vessel density (VD), foveal avascular zone (FAZ) circularity index, and three-dimensional choroidal vascularity volume, along with increased FAZ acircularity index, retinal nerve fiber layer thickness, luminal choroidal area (LCA), stromal choroidal area (SCA), total choroidal area (TCA), and choroidal hyperreflective foci number (CHRF). When comparing patients in remission with their pre-treatment status, reductions were observed in parafoveal thickness, FAZ acircularity index, choroidal thickness, SCA, TCA, and CHRF, whereas perifoveal SCP VD and choroidal vascularity index (CVI) increased. Comparisons between patients with and without leukemic retinopathy revealed no significant differences in retinal and choroidal parameters. Conclusion The observed alterations in FAZ acircularity index, SCA, TCA, and CHRF, along with their post-treatment changes suggest that these imaging biomarkers may serve as indicators of disease activity. Although current evidence is preliminary, these findings underscore potential utility of OCT and OCT-A in monitoring therapeutic response and functioning as early surrogate markers of disease relapse or remission.