Introduction: We investigated the changes of peripapillary and macular microvasculature in idiopathic macular epiretinal membrane (iERM) eyes before and after pars plana vitrectomy (PPV), aiming to identify potential optical coherence tomography angiography (OCTA) predictors of visual acuity improvement. Methods: Fifty-seven eyes diagnosed with iERM were enrolled and underwent PPV with ERM and internal limiting membrane (ILM) peeling. Data were collected before surgery and during the 12-month postoperative period. OCTA analysis focused on radial peripapillary capillary (RPC) vessel density (VD), superficial and deep capillary plexus (SCP and DCP, respectively). Functional and OCT structural outcomes, including best-corrected visual acuity (BCVA) and macular thickness, were also recorded. Results: Multivariate linear regression analysis revealed that higher preoperative RPC VD, lower SCP VD, and lower BCVA were predictors of postoperative BCVA improvement (p < 0.001, p = 0.047, and p < 0.001, respectively). Throughout the follow-up period, there was an observed increase in intradisc RPC VD, whole-disc VD, and parafoveal DCP VD (all p < 0.001). BCVA and central macular thickness demonstrated significant improvement (p < 0.001) within the first month following vitrectomy, which then stabilized from the third month onward. Conclusions: Preoperative microvascular measurements in iERM patients can forecast postoperative BCVA. OCTA findings reveal that both increased RPC density and reduced SCP density at baseline could serve as predictors of better visual outcomes after surgery. Enhanced RPC density may reflect a healthier optic nerve with greater potential for visual recovery, while a less dense SCP could indicate less iERM contraction, both contributing to more favorable postoperative visual results.

1.
Xiao
W
,
Chen
X
,
Yan
W
,
Zhu
Z
,
He
M
.
Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis of population-based studies
.
BMJ Open
.
2017
;
7
(
9
):
e014644
.
2.
Cheung
N
,
Tan
S-P
,
Lee
SY
,
Cheung
GCM
,
Tan
G
,
Kumar
N
, et al
.
Prevalence and risk factors for epiretinal membrane: the Singapore Epidemiology of Eye Disease study
.
Br J Ophthalmol
.
2017
;
101
(
3
):
371
6
.
3.
Kawasaki
R
,
Wang
JJ
,
Mitchell
P
,
Aung
T
,
Saw
S-M
,
Wong
TY
, et al
.
Racial difference in the prevalence of epiretinal membrane between Caucasians and Asians
.
Br J Ophthalmol
.
2008
;
92
(
10
):
1320
4
.
4.
Kim
JM
,
Lee
H
,
Shin
JP
,
Ahn
J
,
Yoo
JM
,
Song
SJ
, et al
.
Epiretinal membrane: prevalence and risk factors from the korea national health and nutrition examination survey, 2008 through 2012
.
Korean J Ophthalmol
.
2017
;
31
(
6
):
514
23
.
5.
Mitchell
P
,
Smith
W
,
Chey
T
,
Wang
JJ
,
Chang
A
.
Prevalence and associations of epiretinal membranes. The blue mountains eye study, Australia
.
Ophthalmology
.
1997
;
104
(
6
):
1033
40
.
6.
Klein
R
,
Klein
BE
,
Wang
Q
,
Moss
SE
.
The epidemiology of epiretinal membranes
.
Trans Am Ophthalmol Soc
.
1994
;
92
:
403
30
.
7.
Meuer
SM
,
Myers
CE
,
Klein
BEK
,
Swift
MK
,
Huang
Y
,
Gangaputra
S
, et al
.
The epidemiology of vitreoretinal interface abnormalities as detected by spectral-domain optical coherence tomography: the beaver dam eye study
.
Ophthalmology
.
2015
;
122
(
4
):
787
95
.
8.
Bu
S-C
,
Kuijer
R
,
Li
X-R
,
Hooymans
JMM
,
Los
LI
.
Idiopathic epiretinal membrane
.
Retina
.
2014
;
34
(
12
):
2317
35
.
9.
Fung
AT
,
Galvin
J
,
Tran
T
.
Epiretinal membrane: a review
.
Clin Exp Ophthalmol
.
2021
;
49
(
3
):
289
308
.
10.
Folk
JC
,
Adelman
RA
,
Flaxel
CJ
,
Hyman
L
,
Pulido
JS
,
Olsen
TW
.
Idiopathic epiretinal membrane and vitreomacular traction preferred practice Pattern(®) guidelines
.
Ophthalmology
.
2016
;
123
(
1
):
P152
81
.
11.
Dawson
SR
,
Shunmugam
M
,
Williamson
TH
.
Visual acuity outcomes following surgery for idiopathic epiretinal membrane: an analysis of data from 2001 to 2011
.
Eye
.
2014
;
28
(
2
):
219
24
.
12.
Asaria
R
,
Garnham
L
,
Gregor
ZJ
,
Sloper
JJ
.
A prospective study of binocular visual function before and after successful surgery to remove a unilateral epiretinal membrane
.
Ophthalmology
.
2008
;
115
(
11
):
1930
7
.
13.
Govetto
A
,
Lalane
RA
,
Sarraf
D
,
Figueroa
MS
,
Hubschman
JP
.
Insights into epiretinal membranes: presence of ectopic inner foveal layers and a new optical coherence tomography staging scheme
.
Am J Ophthalmol
.
2017
;
175
:
99
113
.
14.
Mastropasqua
L
,
Borrelli
E
,
Carpineto
P
,
Toto
L
,
Di Antonio
L
,
Mattei
PA
, et al
.
Microvascular changes after vitrectomy with internal limiting membrane peeling: an optical coherence tomography angiography study
.
Int Ophthalmol
.
2018
;
38
(
4
):
1465
72
.
15.
Navajas
EV
,
Schuck
N
,
Govetto
A
,
Akil
H
,
Docherty
G
,
Heisler
M
, et al
.
EN face optical coherence tomography and optical coherence tomography angiography OF inner retinal dimples after internal limiting membrane peeling for full-thickness macular holes
.
Retina
.
2020
;
40
(
3
):
557
66
.
16.
Mao
J
,
Lao
J
,
Liu
C
,
Zhang
C
,
Chen
Y
,
Tao
J
, et al
.
A study analyzing macular microvasculature features after vitrectomy using OCT angiography in patients with idiopathic macular epiretinal membrane
.
BMC Ophthalmol
.
2020
;
20
(
1
):
165
.
17.
Okawa
Y
,
Maruko
I
,
Kawai
M
,
Hasegawa
T
,
Arakawa
H
,
Iida
T
.
Foveal structure and vasculature in eyes with idiopathic epiretinal membrane
.
PLoS One
.
2019
;
14
(
4
):
e0214881
.
18.
Frisina
R
,
De Salvo
G
,
Tozzi
L
,
Gius
I
,
Sahyoun
J-Y
,
Parolini
B
, et al
.
Effects of physiological fluctuations on the estimation of vascular flow in eyes with idiopathic macular pucker
.
Eye
.
2023
;
37
(
7
):
1470
8
.
19.
Nicolai
M
,
Franceschi
A
,
De Turris
S
,
Rosati
A
,
Carpenè
MJ
,
Danieli
L
, et al
.
Correlation between retinal sensitivity and retinal vascular perfusion after idiopathic epiretinal membrane peeling
.
Eur J Ophthalmol
.
2024
;
34
(
4
):
1228
38
.
20.
Kim
YJ
,
Kim
S
,
Lee
JY
,
Kim
J-G
,
Yoon
YH
.
Macular capillary plexuses after epiretinal membrane surgery: an optical coherence tomography angiography study
.
Br J Ophthalmol
.
2018
;
102
(
8
):
1086
91
.
21.
Chen
H
,
Chi
W
,
Cai
X
,
Deng
Y
,
Jiang
X
,
Wei
Y
, et al
.
Macular microvasculature features before and after vitrectomy in idiopathic macular epiretinal membrane: an OCT angiography analysis
.
Eye
.
2019
;
33
(
4
):
619
28
.
22.
Yoon
K
,
Park
JB
,
Kang
MS
,
Kim
ES
,
Yu
S-Y
,
Kim
K
.
Peripapillary microvasculature changes after vitrectomy in epiretinal membrane via swept-source OCT angiography
.
BMC Ophthalmol
.
2023
;
23
(
1
):
50
.
23.
Bonfiglio
V
,
Ortisi
E
,
Nebbioso
M
,
Reibaldi
M
,
Lupidi
M
,
Russo
A
, et al
.
Optical coherence tomography angiography evaluation OF peripapillary microvascular changes after rhegmatogenous retinal detachment repair
.
Retina
.
2021
;
41
(
12
):
2540
8
.
24.
Lu
B
,
Zhang
P
,
Liu
H
,
Jia
H
,
Yu
Y
,
Wang
F
, et al
.
Peripapillary vessel density in eyes with rhegmatogenous retinal detachment after pars plana vitrectomy
.
J Ophthalmol
.
2021
;
2021
:
6621820
.
25.
Serra
R
,
Pinna
A
,
Carlino
P
,
Giancipoli
E
,
Tadayoni
R
,
Couturier
A
, et al
.
Long-term capillary changes in areas of dissociated optic nerve fibre layer after macular hole surgery
.
Acta Ophthalmol
.
2021
;
99
(
7
):
e1252
3
.
26.
Pichi
F
,
Lembo
A
,
Morara
M
,
Veronese
C
,
Alkabes
M
,
Nucci
P
, et al
.
Early and late inner retinal changes after inner limiting membrane peeling
.
Int Ophthalmol
.
2014
;
34
(
2
):
437
46
.
27.
Gharbiya
M
,
La Cava
M
,
Tortorella
P
,
Abbouda
A
,
Marchiori
J
,
D’Ambrosio
E
, et al
.
Peripapillary RNFL thickness changes evaluated with spectral domain optical coherence tomography after uncomplicated macular surgery for epiretinal membrane
.
Semin Ophthalmol
.
2017
;
32
(
4
):
449
55
.
28.
Mariotti
C
,
Nicolai
M
,
Longo
A
,
Viti
F
,
Bambini
E
,
Saitta
A
, et al
.
Peripapillary retinal nerve fiber thickness changes after vitrectomy for epiretinal membrane in eyes with and without vitreous detachment
.
Retina
.
2017
;
37
(
12
):
2304
9
.
29.
Chua
PY
,
Sandinha
MT
,
Steel
DH
.
Idiopathic epiretinal membrane: progression and timing of surgery
.
Eye
.
2022
;
36
(
3
):
495
503
.
30.
Rahman
R
,
Chaudhary
R
,
Anand
N
.
Verification of posterior hyaloid status during pars plana vitrectomy, after preoperative evaluation on optical coherence tomography
.
Retina
.
2012
;
32
(
4
):
706
10
.
31.
Bringmann
A
,
Unterlauft
JD
,
Barth
T
,
Wiedemann
R
,
Rehak
M
,
Wiedemann
P
.
Foveal configurations with disappearance of the foveal pit in eyes with macular pucker: presumed role of Müller cells in the formation of foveal herniation
.
Exp Eye Res
.
2021
;
207
:
108604
.
32.
Govetto
A
,
Bhavsar
KV
,
Virgili
G
,
Gerber
MJ
,
Freund
KB
,
Curcio
CA
, et al
.
Tractional abnormalities of the central foveal bouquet in epiretinal membranes: clinical spectrum and pathophysiological perspectives
.
Am J Ophthalmol
.
2017
;
184
:
167
80
.
33.
Kim
K
,
Yoon
K
,
Park
JB
,
Kang
MS
,
Kim
ES
,
Yu
SY
.
Perifoveal microvascular changes following internal limiting membrane peeling surgery for epiretinal membrane and macular hole
.
Ophthalmologica
.
2023
;
246
(
5–6
):
324
32
.
34.
Zhu
ZH
,
Zhao
YY
,
Zou
R
,
Zou
H
,
Fang
JY
,
Chang
PJ
, et al
.
Evaluation of optic nerve head vessels density changes after phacoemulsification cataract surgery using optical coherence tomography angiography
.
Int J Ophthalmol
.
2023
;
16
(
6
):
884
90
.
35.
Brazitikos
PD
,
Katsimpris
JM
,
Tsironi
E
,
Androudi
S
.
Retinal nerve fiber layer thickness evaluation after trypan blue-assisted macular surgery
.
Retina
.
2010
;
30
(
4
):
640
7
.
36.
Lalezary
M
,
Shah
RJ
,
Reddy
RK
,
Kammer
JA
,
Kuchtey
RW
,
Joos
KM
, et al
.
Prospective retinal and optic nerve vitrectomy evaluation (PROVE) study: twelve-month findings
.
Ophthalmology
.
2014
;
121
(
10
):
1983
9
.
37.
Balducci
N
,
Morara
M
,
Veronese
C
,
Torrazza
C
,
Pichi
F
,
Ciardella
AP
.
Retinal nerve fiber layer thickness modification after internal limiting membrane peeling
.
Retina
.
2014
;
34
(
4
):
655
63
.
38.
Arroyo
JG
,
Irvine
AR
.
Retinal distortion and cottonwool spots associated with epiretinal membrane contraction
.
Ophthalmology
.
1995
;
102
(
4
):
662
8
.
39.
Kumagai
K
,
Hangai
M
,
Ogino
N
.
Progressive thinning of regional macular thickness after epiretinal membrane surgery
.
Invest Ophthalmol Vis Sci
.
2015
;
56
(
12
):
7236
42
.
40.
Massin
P
,
Allouch
C
,
Haouchine
B
,
Metge
F
,
Paques
M
,
Tangui
L
, et al
.
Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery
.
Am J Ophthalmol
.
2000
;
130
(
6
):
732
9
.
41.
Aso
H
,
Iijima
H
,
Imai
M
,
Gotoh
T
.
Temporal changes in retinal thickness after removal of the epiretinal membrane
.
Acta Ophthalmol
.
2009
;
87
(
4
):
419
23
.
42.
Sayegh
RG
,
Georgopoulos
M
,
Geitzenauer
W
,
Simader
C
,
Kiss
C
,
Schmidt-Erfurth
U
.
High-resolution optical coherence tomography after surgery for vitreomacular traction: a 2-year follow-up
.
Ophthalmology
.
2010
;
117
(
10
):
2010
7.e20172
.
43.
Treumer
F
,
Wacker
N
,
Junge
O
,
Hedderich
J
,
Roider
J
,
Hillenkamp
J
.
Foveal structure and thickness of retinal layers long-term after surgical peeling of idiopathic epiretinal membrane
.
Invest Ophthalmol Vis Sci
.
2011
;
52
(
2
):
744
50
.
44.
Govetto
A
,
Virgili
G
,
Rodriguez
FJ
,
Figueroa
MS
,
Sarraf
D
,
Hubschman
JP
.
Functional and anatomical significance OF the ectopic INNER foveal layers IN eyes with idiopathic EPIRETINAL membranes: surgical results at 12 months
.
Retina
.
2019
;
39
(
2
):
347
57
.
45.
Ekici
E
,
Moghimi
S
,
Bowd
C
,
Hou
H
,
Penteado
RC
,
Proudfoot
J
, et al
.
Capillary density measured by optical coherence tomography angiography in glaucomatous optic disc phenotypes
.
Am J Ophthalmol
.
2020
;
219
:
261
70
.
46.
Spaide
RF
,
Fujimoto
JG
,
Waheed
NK
.
Image artifacts in optical coherence tomography angiography
.
Retina
.
2015
;
35
(
11
):
2163
80
.
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