Objective To investigate the relationship between morphologic macular changes and visual outcome in eyes with persistent submacular fluid (SMF) after surgery for macula-off rhegmatogenous retinal detachment (RRD) and the relevant factors of persistent submacular fluid. Methods Sixty-three consecutive patients (63 eyes) who underwent successful surgery for macula-off RRD were enrolled in this retrospective study. The patients were divided into three groups according to duration of SMF: no SMF group, short-term group (duration of SMF less than three months) and long-term group (duration of SMF more than three months). The follow-up ranged from six to 12 months. The morphologic macular changes, height of SMF and thickness of the outer nuclear layer (ONL) one month after surgery were assessed by spectral domain-optical coherence tomography (SD-OCT). The relationship between morphologic macular changes and logarithm of the minimum angle of resolution (logMAR) visual acuity and the relevant factors of persistent SMF were evaluated. Results Forty-five of 63 eyes (71.42%) presented morphologic changes after surgery. SMF was detected in 32 eyes (50.79%), which included 21 patients that had long-term course of SMF. Irregular thickness of the photoreceptor outer segments (OS) was observed in 23 eyes; disrupted inner segment/outer segment (IS/OS) junction was noted in 21 eyes, and disrupted external limiting membrane (ELM) was noted in 14 eyes. Irregular thickness of OS in long-term group was significantly higher than that in short-term group (chi;2=5.788, P=0.035). The proportion of IS/OS disruption and ELM discontinuation in long-term group was also higher than those in short-term group, but there was no statistically significant difference (chi;2=0.744, 0.375; P=0.472, 0.403). The postoperative visual acuity correlated positively with preoperative visual acuity and the time of retinal detachment (r=0.611, -0.374; P=0.007, 0.037). There was a significant difference of postoperative logMAR visual acuity (U=28.640, P=0.049) among no SMF group (0.27plusmn;0.26), short-term group (0.42plusmn;0.31) and long-term group (0.53plusmn;0.41). The postoperative visual acuity was insignificantly associated with irregular OS and IS/OS disruption (r=0.331, 0.320; P=0.073, 0.102). The irregular OS correlated positively with IS/OS disruption (r=0.388, P=0.027). The postoperative visual acuity in eyes with disrupted both IS/OS and ELM significantly decreased (U=29.920, P=0.036). The surgery manner (r=0.477, P＜0.001), time of preoperative retinal detachment (r=0.354, P=0.047) and SMF height one month after surgery (r=0.375, P=0.039) were factors influencing persistent SMF. Conclusions The incidence of postoperative photoreceptor lesion was increased with time of persistent SMF. Disruption of both IS/OS and ELM after surgery means a poorer vision outcome. Duration of preoperative macular detachment, type of surgery and SMF heights one month after surgery were important factors for persistent SMF.