Objective: This study aimed to assess microvascular changes in the retina over time in patients with chronic kidney disease (CKD) following kidney transplantation. Methods: A total sample of 54 CKD patients (108 eyes) was prospectively observed for 2 years to evaluate the dynamics of microvascular parameters. Two study groups were formed: Group 1 comprised 36 patients (72 eyes) who underwent kidney transplantation, and Group 2 comprised 18 patients (36 eyes) receiving hemodialysis and conservative treatment. Patients were examined before the operation, within 2 months post-operation (early postoperative period), and at 12 months post-operation (late postoperative period). Results: Optical coherence tomography angiography (OCTA) results demonstrated that retinal parameters, including area, perimeter, and circularity index of the foveal avascular zone (FAZ), showed recovery over the 12-month observation period after kidney transplantation, indicating a positive trend in the macular region. Similar trends were observed for overall vessel density, perfusion, and choroidal vascularity index (CVI) parameters. Statistical analysis revealed significant differences (p<0.05) between the groups in terms of FAZ area and CVI. Conclusion: The primary microvascular changes in the retinas of patients with end-stage CKD involve reduced vessel density and perfusion volume in the superficial capillary layer.