To investigate the clinical features and surgical outcomes of idiopathic macular holes (IMHs) with epiretinal proliferation (EP).This retrospective study included 282 eyes of 269 consecutive patients who underwent vitrectomy for IMHs. Clinical demographic data, baseline and postoperative retinal microstructure features on optical coherence tomography images, best-corrected visual acuity (BCVA), and postoperative closure rate were compared between eyes with and without EP.EP was identified in 38 of 282 eyes (13.5%). Eyes with EP had a significantly longer symptom duration (P = 0.019), higher frequency of pseudophakic conditions (P = 0.034), presence of epiretinal membrane (P < 0.001), and a larger base diameter (P = 0.014) than those without EP. Additionally, compared with eyes without EP, those with EP had a higher percentage of U-type closure (P = 0.047) and thicker central fovea (P = 0.012) at 1 month postoperatively; a significantly lower frequency of ellipsoid zone disruption (P = 0.033) and outer foveolar lucency (P = 0.021) and a thicker central fovea (P = 0.004) at 10 months postoperatively.The presence of EP represents a more chronic pathogenic process but has no negative effect on postoperative outcomes and can even facilitate anatomical recovery after surgery.