By contrasting macula-off rhegmatogenous retinal detachment (RRD) with central serous chorioretinopathy (CSC), hemodynamic changes in macula-off rhegmatogenous retinal detachment (RRD) and their impact on visual prognosis were investigated for a study. In macula-off RRD and CSC eyes, vascular density in the superficial capillary plexus and deep capillary plexus (DCP) was retrospectively compared with contralateral unaffected eyes using optical coherence tomography angiography (OCTA). Pre-and postoperative ultra-widefield (UWF) fluorescein angiography (FA) was performed to assess vascular alterations in RRD eyes. Both macula-off RRD and CSC eyes had reduced density in macular DCP in OCTA compared to unaffected peers. Eyes afflicted by macula-off RRD exhibited a lower DCP vascular density and a higher foveal avascular zone than eyes affected by CSC while having a shorter macular detachment duration. Less DCP density was linked to a longer length of detachment, more ellipsoid zone disturbance, and poor visual recovery in macula-off RRD. Detached retinas in UWF-FA demonstrated capillary hypoperfusion, venous stasis, and leakage, all of which improved after reattachment. Finally, the duration of RRD detachment was related to macular capillary flow decrease, which was linked to photoreceptor disruption. Early reattachment and reperfusion were necessary for macula-off RRD to minimize macular vascular and photoreceptor loss.