Relationship between the morphology of the foveal avascular zone and the degree of aniseikonia before and after vitrectomy in patients with unilateral epiretinal membrane

  • Akira HirataEmail author
  • Hiroya Nakada
  • Keiko Mine
  • Miki Masumoto
  • Tatsuhiko Sato
  • Ken Hayashi
Retinal Disorders



Persistent metamorphopsia, particularly aniseikonia, is a troublesome problem which may occur after epiretinal membrane (ERM) surgery. To clarify if the preoperative foveal avascular zone (FAZ) morphology can be used as a predictor of postoperative residual aniseikonia, the morphological changes in the FAZ and the degree of aniseikonia between before and 12 months after vitrectomy for epiretinal membrane (ERM) were measured and analyzed.


Thirty patients, each with a unilateral idiopathic ERM, who underwent treatment between September 2016 and March 2017 were enrolled for this prospective case series study. Best-corrected visual acuity (BCVA), the degree of aniseikonia, central foveal thickness (CFT), FAZ area (FAZa), perimeter (FAZp), and circularity in ERM eyes were examined before and 1, 3, 6 and 12 months after surgery. The fellow eye without an ERM was also examined and used as the control. The interocular ratios of the CFT, FAZa, and FAZp in ERM eyes with those in control eyes were also calculated. Multiple regression analysis was performed on preoperative parameters that were found to be significantly correlated with the 12-month aniseikonia in univariate analyses.


The BCVA in the ERM eyes was significantly improved at 1 month after surgery (P < .0001) The degree of aniseikonia was significantly reduced only after 12 months (P = .004). The CFT had decreased significantly by 3 months after the surgery and continued decreasing thereafter (P < .0001). Both FAZa and FAZp were significantly smaller in the ERM eyes than in the control eyes throughout the study period (P < .0001 and P < .0001, respectively), with no change in either parameter over the study period. Correlation analyses revealed that the degree of aniseikonia was significantly correlated with pre- and postoperative CFT, CFT ratio, FAZa, FAZa ratio, FAZp, and FAZp ratio. Within preoperative OCT parameters, FAZa ratio remained significant after multiple regression analysis was performed (P < .0001).


Aniseikonia changed little over the long term following ERM surgery. Preoperative FAZ area ratio was identified as a significant predictor of postoperative aniseikonia.


Epiretinal membrane Foveal avascular zone Optical coherence tomography Optical coherence tomography angiography Vitrectomy Aniseikonia 


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Hayashi Eye Hospital institutional review committee and with the 1964 Helsinki declaration.

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Hayashi Eye HospitalFukuokaJapan

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