Background <p>As COVID-19 was found to affect small vessels of multiple organ systems, the purpose of the study is to describe the macular vessel density (VD) and the area of the foveal avascular zone (FAZ) by optical coherence tomography angiography (OCTA) in patients who recovered from a COVID-19 disease, who were or were not treated in an Intensive Care Unit (ICU) and who suffer from fatigue due to long COVID.</p> Methods <p>Prospective case-control study in which laboratory-confirmed and recovered COVID-19 patients were included. Macular OCTA was performed at least seven weeks after initial COVID-19. The VD of the superficial retinal capillary plexus (SCP) and the area of the FAZ were measured. Results were compared among ICU- and non-ICU COVID-19 patients and a healthy control group; moreover, patients were divided into groups of no fatigue, fatigue, and extreme fatigue and results were compared among these and a control group.</p> Results <p>FAZ of non-ICU patients was significantly enlarged compared to control group. VD was not significantly different among these cohorts. FAZ of fatigue group was significantly enlarged compared to no fatigue group and control group. VD of extreme fatigue group was significantly greater than VD of both no fatigue group and control group.</p> Conclusion <p>The retinal microvasculature of recovered COVID-19 patients showed alterations in the sense of a significantly enlarged FAZ, particularly in patients with mild disease and fatigue. These microvascular manifestations may lead to future complications or visual impairment. Performing macular OCTA could be a possible monitoring tool for microvascular changes in these patients and a predictor for long COVID fatigue.</p>