Purpose <p>To investigate the relationship between metamorphopsia and retinal structural changes using optical coherence tomography angiography (OCTA) images before and after macular hole (MH) surgery.</p> Study design <p>Retrospective, consecutive, case series.</p> Methods <p>Twenty-seven eyes of 27 patients undergoing MH surgery with internal limiting membrane peeling were studied. M-CHARTS (MC) was used to evaluate metamorphopsia. Retinal distances were measured between two sets of retinal vessel bifurcations that cross the macula vertically and horizontally near and distal to the macula using OCTA 3x3 mm en face images. The rate of change in retinal distance was defined as retinal displacement%. Basal and minimum MH diameters and retinal thicknesses were measured using Spectralis.</p> Results <p>The vertical and horizontal MC scores improved postoperatively (<i>P</i>&lt;0.001). The retinal distance decreased in all periods (<i>P</i>&lt;0.001), and retinal displacements% was greater near than distal to the center of the macula (<i>P</i>&lt;0.001). Retinal displacement% was correlated with basal MH diameter (r_s=−0.419 to −0.280, <i>P</i>&lt;0.001 to 0.045). The horizontal MH diameter was a significant factor related to vertical MC score at baseline and 6 months postoperatively (<i>P</i> value range: <i>P</i>=0.002–0.004). The rates of change in outer retinal thickness and retinal displacement% near the center of the macula were significant factors related to horizontal MC scores at 6 months (<i>P</i>&lt;0.001).</p> Conclusion <p>Retinal displacement near the macular region contributes to MH closure after surgery. The larger the MH diameter, the greater the retinal displacement near the macula and the degree of residual postoperative metamorphopsia.</p>