PURPOSE: To determine whether pre and/or postoperative optical coherence tomography (OCT) evaluation of the fovea is useful in explaining delayed or incomplete visual acuity recovery after successful surgery for shallow macula-off retinal detachments. METHODS: Prospective study of 16 patients (10 female, 6 male; mean age 53+/-4 years) with a spontaneous rhegmatogenous retinal detachment with peripheral breaks and a shallow elevation of the fovea. Patients were examined by OCT preoperatively and at 1, 6, and 10-12 months after surgery. At 1 month after surgery, fluorescein angiography was also performed. Mean follow-up was 11.0+/-1.0 months. RESULTS: Preoperative OCT images could be classified into four categories according to the extent of retinal edema and presence of foveal depression. The extent of retinal edema in the detached macula did not correlate with preoperative or postoperative vision. In 11 cases, OCT images at 1 month after surgery showed a foveal detachment with residual subretinal fluid that was not visible clinically or on angiography. Long-term persistence of this fluid could be observed in eight cases at 6 months and in one case at 12 months, and was associated with incomplete recovery of visual acuity. CONCLUSIONS: Preoperative OCT of the detached macula can demonstrate widespread retinal edema, the extent of which does not appear to influence final postoperative vision. Delayed and incomplete visual recovery after successful reattachment of the retina may, however, be due to persistent circumscribed subfoveal fluid accumulation that is visible only on OCT not clinically or on fluorescein angiography.