AIM: To summarize and quantitatively evaluate vasculature alteration of foveal zone in systemic lupus erythematosus (SLE) patients by secondary literature analysis. METHODS: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI WanFang Data and VIP was conducted. Studies were about retinal vessel density in SLE patients from January 2000 to April 2023 and valid data were extracted. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the cross-sectional studies and prospective studies. The measurement data for combined effect size were weighted mean difference (WMD) and 95% confidence interval (CI). The heterogeneity was evaluated by I2 test. The fixed-effect model was adopted when P>0.1 or I2<50%, and random-effect model was adopted in the contrary. Subgroup and sensitivity analysis were utilized to analyze the sources of heterogeneity. The publication bias was evaluated by Egger tests and funnel plots. RESULTS: A total of 14 studies with 445 subjects and 441 healthy controls from 9 countries were enrolled and 11 studies were included in Meta-analysis. The JBI scores of studies were no less than 14 points. The Meta-analysis results indicated that mean parafoveal superficial vessel density (SVD; WMD=-1.22, 95%CI: -1.67, -0.76), mean perifoveal SVD (WMD=-1.42, 95%CI: -1.95, -0.89), mean whole SVD (WMD=-1.66, 95%CI: -2.53, -0.79), mean parafoveal deep vessel density (WMD=-1.67, 95%CI: -2.75, -0.59) and mean whole deep vessel density (WMD= -4.09, 95%CI: -7.67, -0.52) was significantly lower than the control, while mean foveal SVD (WMD=-1.71, 95%CI: -4.65, 1.24), mean foveal avascular zone (FAZ) area (WMD=0.04, 95%CI: -0.01, 0.09) and mean acircularity index (AI; WMD=0.00, 95%CI: -0.02, 0.02) were not different between SLE patients and controls. Subgroup analysis indicated that the heterogeneity in SVD was partially due to the scanning area. Ocellus or binoculus data contributed partially to the heterogeneity in parafoveal deep vessel density and FAZ area. Sensitivity analysis indicated that the results were robust after changing the analysis model except for foveal SVD and FAZ area. There was no bias in included studies except whole SVD. CONCLUSION: Parafoveal superficial and deep vessel density are significantly lower in SLE patients while FAZ area and AI are not different between SLE patients and the control.