PURPOSE:: To evaluate preoperative factors influencing the visual outcome and postoperative factors associated with the changes in visual acuity, after reattachment surgery to treat macula-off rhegmatogenous retinal detachment. METHODS:: A total of 180 eyes of 180 patients who underwent reattachment surgery to treat macula-off rhegmatogenous retinal detachment, and who were followed up for more than 12 months, were reviewed retrospectively. Preoperative and postoperative characteristics, including optical coherence tomography findings, were comprehensively analyzed using univariate and multivariate models to evaluate preoperative factors influencing best-corrected visual acuity 12 months after macula-off rhegmatogenous retinal detachment surgery and postoperative factors associated with... changes in best-corrected visual acuity after surgery. RESULTS:: Preoperatively, the extent of detachment (P = 0.037), macula-off duration (P < 0.001), and integrity of the external limiting membrane (β = 0.163; P = 0.002) were significantly associated with postoperative visual prognosis. Six factors were associated with changes in visual acuity after surgery: disruption of ellipsoid zone integrity (β = 0.167; P < 0.001), the Henleʼs fiber layer and the outer nuclear layer (HFL + ONL)/photoreceptor layer ratio (β = 0.199; P < 0.001), the photoreceptor outer segment length (β = −0.020; P < 0.001), the photoreceptor inner segment length/photoreceptor outer segment length ratio (β = 0.047; P = 0.005), the ratio of photoreceptor layer thickness between the RD eye and fellow eye (β = −0.126; P = 0.018), and the photoreceptor outer segment length ratio between the RD eye and fellow eye (β = −0.425; P < 0.001). CONCLUSION:: Preoperative factors associated with the visual outcome after macula-off rhegmatogenous retinal detachment surgery were the extent of detachment, macula-off duration, and external limiting membrane integrity. Postoperatively, predictive factors were the outer retinal microstructures, particularly the photoreceptor outer segment layer.