Abstract Background To detect changes in the macular vascular profile after macular hole closure using modified classic internal limiting membrane (ILM) peeling and temporal ILM flap techniques and their correlation with the macular microstructure and visual function. Patients and methods Prospective comparative study that included 50 eyes with primary full-thickness macular hole (FTMH). Group A ( n = 25) was treated using the modified classic ILM peeling technique, whereas group B ( n = 25) was treated using the temporal ILM flap technique. The main outcome measures were macular hole closure, macular vascular and structural repair, and visual recovery rates. We performed OCT and OCTA using spectral-domain OCT (SD-OCT). The chi-square test was used to compare qualitative data, and the independent t-test was used to compare quantitative data. Analysis of variance test (ANOVA) was used to compare paired groups, and Spearman’s correlation coefficients were used to assess the correlations between quantitative parameters. P-value < 0.05. Results Anatomical closure was comparable between groups A (80%) and B (88%) ( p = 0.44). Both groups showed significant improvement in BCVA ( p < 0.001), with no intergroup differences. The reduction in the FAZ area in the DCP was significant in both groups ( p < 0.001). Only Group A showed a significant reduction in the FAZ in the SCP ( p < 0.001). Preoperative hole dimensions correlated negatively with baseline BCVA and positively with FAZ in the SCP. Central macular thickness was inversely correlated with FAZ in both plexuses postoperatively. The magnitude of change in the FAZ in the DCP correlated negatively with the BCVA in groups A and B ( p = 0.034 and p = 0.043, respectively). Conclusion Free ILM peeling and temporal ILM flap techniques achieved comparable anatomical closure rates and sustained visual improvement. Preoperative hole dimensions are major determinants of structural remodeling and functional recovery, while OCTA reveals substantial microvascular rearrangement, especially within the DCP, which correlates with visual recovery. Clinical trial number Not applicable.
Hussein et al. (2026) studied this question.