BACKGROUND AND OBJECTIVE: To evaluate macular microstructural changes after macula-involving rhegmatogenous retinal detachment repair and correlate with visual recovery. PATIENTS AND METHODS: A prospective, observational study was performed of select patients presenting with macula-involving rhegmatogenous retinal detachments (RRD). Spectral-domain optical coherence tomography (SD-OCT) imaging was performed at postoperative visits over the course of the first year after operative repair of the RRD. RESULTS: The maculas of seven patients were evaluated. Postoperative best corrected visual acuity (BCVA) at the final follow-up ranged from 20/20 to 20/70 for all patients. Eyes with final BCVA greater than 20/40 had intact external limiting membrane and outer photoreceptor structures, while those with BCVA of less than 20/70 had poorer definition to those structures. Serial images showed resolution of irregularities in both the external limiting membrane and outer photoreceptor structures. CONCLUSION: Macular structure and function can progressively improve in the first year after successful RRD repair, including in the external limiting membrane, damage to which has previously been thought to be irreversible. SD-OCT serves as a useful tool to monitor postoperative retinal recovery.