The present study examined the relationships among macular microvasculature, retinal structure, and epiretinal membrane (ERM) and explored the utility of optical coherence tomography (OCT) angiography (OCTA) in idiopathic ERM assessment. The study sample comprised 276 eyes of 276 patients. A total of 154 eyes with ERM and 122 normal (control) eyes were analyzed. Only one eye of each participant was randomly selected for posterior segment imaging. Each patient underwent OCT and OCTA. Images were analyzed with AngioTool 0.6. Foveal avascular zone was significantly smaller in the ERM group (p = 0.044). Average retinal thickness and foveal thickness were significantly higher in the ERM group (both p = 0.001). Moreover, 64 (41.5%) patients exhibited no metamorphopsia, while 46 (29.8%) and 44 (28.7%) patients exhibited moderate and extensive metamorphopsias, respectively. Meanwhile, FAZ was negatively correlated with central retinal thickness in the ERM group. The vessel area (p = 0.0017) and vessel percentage area (p = 0.044) were significantly greater in the ERM group. Changes observed in the superficial plexus in OCTA are related to the severity of metamorphopsia and can be further evaluated to support decision making regarding the surgical management of idiopathic ERM.

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