Long-term assessment of foveal microvascular remodeling after vitrectomy for full-thickness macular hole using optical coherence tomography angiography

Purpose: To evaluate long-term changes in the superficial capillary plexus (SCP) and foveal avascular zone (FAZ) following vitrectomy for idiopathic full-thickness macular hole (FTMH) using optical coherence tomography angiography (OCTA), and to assess correlations between microvascular parameters and postoperative visual outcomes. Methods: Thirty-three patients with idiopathic FTMH underwent 23-gauge pars plana vitrectomy with internal limiting membrane peeling and SF₆ gas tamponade. OCTA measurements, including SCP vessel density and FAZ area, as well as best-corrected distance (DBCVA) and near (NBCVA) visual acuity, were recorded preoperatively and 12 months postoperatively. Results: Total SCP vessel density significantly decreased from 46.25 ± 2.95% to 44.50 ± 3.85% (p < 0.05), with the greatest reductions in the parafoveal temporal (p < 0.001) and nasal (p < 0.01) regions. FAZ area showed no significant change (p = 0.387). DBCVA improved significantly from 1.097 to 0.523 logMAR (p < 0.001). Postoperative visual outcomes correlated strongly with minimum (rs = 0.69, p < 0.001) and basal macular hole diameters (rs = 0.57, p < 0.001), but not with SCP density. Conclusion: Vitrectomy for FTMH induces long-term reductions in SCP vessel density without significant FAZ change. Functional recovery depends primarily on preoperative anatomical parameters rather than microvascular remodeling.