Beyond pelvic pathology: retinal microvascular rarefaction as a systemic marker in endometriosis

This study aimed to quantitatively assess retinal microvascular alterations in women with pelvic endometriosis using optical coherence tomography angiography (OCTA), and to explore whether these subclinical findings may reflect early signs of systemic microvascular alterations in this population.

In this retrospective cross-sectional study, 100 eyes were analyzed-50 from women with laparoscopically or ultrasonographically confirmed pelvic endometriosis and 50 from age-matched healthy female controls. All participants underwent comprehensive ophthalmic examinations and macular OCTA imaging using the Heidelberg Spectralis system. Quantitative parameters, including vessel area density (VAD), foveal avascular zone (FAZ) metrics (area, perimeter, circularity), and FD-300 values, were extracted from the superficial and deep capillary plexuses using the OCTAVA software. Segmental parafoveal VAD values (nasal, temporal, superior, and inferior) were also assessed. Axial length measurements and endometriosis staging were not available in this retrospective dataset. Hormonal therapy use was not systematically documented.

Compared to healthy controls, women with endometriosis demonstrated significantly lower total and parafoveal VAD and FD-300 values in both retinal plexuses (p < 0.05 for all). FAZ perimeter showed a modest but statistically significant difference, whereas FAZ area and circularity index remained comparable between groups. No participant in either group exhibited clinically visible retinal pathology. These alterations occurred despite preserved visual acuity and in the absence of systemic comorbidities known to affect microcirculation.

Although causality cannot be inferred from this cross-sectional design, our findings indicate that pelvic endometriosis is associated with region-specific subclinical reductions in retinal capillary perfusion, particularly within the foveal and parafoveal regions. OCTA-derived metrics, especially FD-300 and parafoveal VAD, may offer insight into microvascular integrity in this patient group. These results support further investigation into the systemic vascular aspects of endometriosis and highlight the potential utility of retinal imaging in exploring such associations.