Objectives: To study the macular microstructural changes and their relation to visual acuity following primary vitrectomy and silicone tamponade for retinal detachment. Patients and methods: 40 cases with macula-off rhegmatogenous retinal detachment underwent 23g vitrectomy with silicone oil tamponade. Cases with open globe injury and macular pathology were excluded. OCT imaging of the macula was done about 3 months and 6 months post-operatively. OCT macular microstructural changes were recorded and correlated to visual acuity. Results: 36 eyes were evaluated by statistical analysis. All patients achieved complete postoperative reattachment with 100% single operation success rate. The mean 6-month postop BCVA (LogMAR) was 0.97 ± 0.5 and the median was 0.8 in a range of 0.3 - 2. The BCVA improved in 35 patients (97.2%) and remained unchanged in 1 patient (2.8%). The greatest visual outcome achieved was LogMAR of 0.3 which occurred in 6 patients (16.7%). No or mild disruption of retinal microstructure occurred in 61.1% of cases. While, severe disruption was found in 38.9%. Epiretinal membrane formed in 5 eyes (13.9%). Conclusion: Macular microstructural changes detected by OCT is directly correlated to visual outcomes of retinal detachment repair