LAYER-SPECIFIC MICROVASCULAR CHANGES IN IDIOPATHIC EPIRETINAL MEMBRANE: Implications for Visual Function

To investigate layer-specific microvascular changes in the nerve fiber layer plexus (NFLP) and ganglion cell layer plexus (GCLP) using optical coherence tomography angiography and correlate them with visual outcomes after surgery for idiopathic epiretinal membrane.

This retrospective study analyzed 47 eyes with idiopathic epiretinal membrane and 30 healthy control eyes. Preoperative and 6-month postoperative best-corrected visual acuity, retinal sensitivity, and optical coherence tomography angiography-derived vascular density were assessed in the NFLP, GCLP, and superficial vascular complex. Diagnostic accuracy was evaluated using receiver operating characteristic curves, and prognostic value was determined through correlation and multiple linear regression analyses.

Preoperatively, idiopathic epiretinal membrane eyes showed significantly increased vascular density and perfusion area in the NFLP, GCLP, and superficial vascular complex compared with control eyes ( P < 0.01). Nerve fiber layer plexus parameters demonstrated superior diagnostic accuracy over superficial vascular complex metrics. Preoperatively, increased NFLP vascular metrics were associated with higher best-corrected visual acuity improvement (all P < 0.05). Conversely, greater baseline 6 mm 2 × 6 mm 2 GCLP vascular metrics were associated with a lower best-corrected visual acuity improvement (all P < 0.05). In multivariate analysis, preoperative GCLP vascular density was an independent predictor of both better final postoperative best-corrected visual acuity (β = 1.84, P = 0.045) and higher postoperative retinal sensitivity (β = 0.048, P < 0.001).

Stratified analysis of the NFLP and GCLP through optical coherence tomography angiography provides distinct and powerful biomarkers for idiopathic epiretinal membrane. Nerve fiber layer plexus metrics excel in diagnosis, whereas preoperative GCLP integrity is a key predictor of postoperative functional recovery, offering more nuanced insights than traditional superficial vascular complex analysis.