Background: since the early use, silicone oil (SO) has been used as long-term retinal endotamponade to manage complicated retinal diseases such as proliferative vitreoretinopathy, advanced proliferative diabetic retinopathy, and complex retinal detachment. A favorable anatomical success was reported after SO injection. Objective: the aim of this study was to investigate the macular microstructural changes in eyes filled with silicone oil (SO) and course of these changes after SO removal, to determine the possible cause of unexplained visual loss by the use of optical coherence tomography and fundus fluorescein angiography. Patients and Methods: This prospective observational study included a total of 40 eyes of 40 adult patients of both sexes with rhegmatogenous retinal detachment and scheduled for pars plana vitrectomy with silicone oil tamponade attending at ophthalmology outpatient clinic of Al-Azhar University Hospitals. This study was conducted between October 2015 to August 2018. Results: There were insignificant differences in visual prognosis between the group with persistent SRF and the group without. But VA bad prognosis can be explained through the other OCT finding not only the SRF. This confirm our conclusion of the importance of OCT examination after successful retinal detachment repair operation for VA prognosis prediction. In our study there was no difference between OCT finding before SOR and after, this means that duration of 3-month silicon oil tamponading is a safe duration. Conclusion: Delayed or incomplete visual recovery after uncomplicated surgery for macula-off retinal detachment may be related not only to persistent subretinal fluid, but also to other pathological changes.