Objectives: To study the macular microstructural changes and their relationship to visual acuity (VA) following primary vitrectomy and silicone tamponade for retinal detachment. Patients and methods: A total of 40 cases with macula-off rhegmatogenous retinal detachment underwent 23-gauge vitrectomy with silicone oil tamponade. Cases with open globe injury and other ocular pathology were excluded. Optical coherence tomography (OCT) imaging of the macula was done about 3 and 6 months postoperatively. OCT macular microstructural changes were recorded and correlated to VA. Results: A total of 36 eyes were evaluated by statistical analysis. The best-corrected VA (BCVA) improved in 35 patients (97.2%) and remained unchanged in one patient (2.8%). Patients were divided into two groups based on 6-month postoperative BCVA: group I with 6-month postoperative BCVA of ,1 LogMAR and group II with 6-month postoperative BCVA of $1 LogMAR. No disruption of retinal microstructure occurred in 70% of cases in group I. Mild disruption was found in 30% of group I and 25% of group II, whereas severe disruption was found in 75% of group II cases. Epiretinal membrane formed early in three eyes in group II and late in two eyes in group I. Conclusion: Macular microstructural changes detected by OCT is directly correlated to visual outcomes of retinal detachment repair.