To compare postoperative changes in peripapillary retinal nerve fiber layer (pRNFL) thickness between macula-off and macula-on rhegmatogenous retinal detachment (RRD). Patients with RRD who had undergone a single, uncomplicated vitrectomy and been followed for ≥ 3 years postoperatively were included. Based on preoperative status, patients were categorized into a macula-on group (Group 1) and a macula-off group (Group 2). The baseline was established after complete gas dissipation from the vitreous cavity, followed by three additional examinations at 1-year intervals. In total, 62 eyes were analyzed: 30 in Group 1 and 32 in Group 2. Global pRNFL thicknesses in Group 1 were 100.0 ± 19.5, 99.4 ± 19.6, 98.4 ± 19.4, and 97.0 ± 20.3 μm at baseline, 1 year, 2 years, and 3 years, respectively (P = 0.001). In Group 2, the corresponding values were 99.6 ± 15.0, 96.2 ± 16.4, 95.4 ± 16.3, and 94.1 ± 17.6 μm (P < 0.001). Sectoral analysis showed statistically significant changes in the inferotemporal (P < 0.001) and inferonasal (P = 0.003) sectors in Group 2. The reduction rates of global pRNFL thickness were - 0.89 μm/y in Group 1 and - 1.81 μm/y in Group 2; these rates significantly differed between the groups (P = 0.026). Among RRD patients, pRNFL thickness gradually declined over time, with a more pronounced reduction in the macula-off group. A substantial decrease in inferior pRNFL thickness was observed in macula-off patients.