To evaluate the macular microstructure repair and explore the factors related to those changes and visual improvement after vitrectomy for idiopathic macular hole (IMH). Totally 19 eyes of 18 IMH patients who underwent macular hole (MH) surgery were evaluated with best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) images. All 19 eyes closed at 6mo postoperatively. BCVA was observed gradually improved (P<0.001), with subretinal fluid (SRF) gradually absorbed (P=0.021) and the rate of external limiting membrane (ELM) defects gradually decreased (P=0.011) with follow-up time. Poorer postoperative logMAR BCVA correlated with larger MH minimum diameter (P<0.001), larger MH basal diameter (P=0.008), longer symptom duration (P=0.002) and poorer preoperative logMAR BCVA (P=0.010). More improvement in BCVA correlated only with poorer preoperative in logMAR BCVA (P=0.002). The earlier reconstruction of ELM was associated with smaller MH basal diameter (P=0.022) and shorter symptom duration (P=0.008). In conclusion, smaller basal diameter of MH and shorter symptom duration were key factors in earlier reconstruction of ELM.