Purpose: The primary goal of this study was to investigate the functional results after scleral buckling (SB) surgery in macula-off rhegmatogenous retinal detachment (RRD), with more or less than 7 days’ duration of macular detachment (DMD). The secondary outcome measure was to determine the long-term functional results in these two groups 5 years after SB surgery. Methods: The retrospective studies included 96 eyes of 96 patients with primary, uncomplicated, macula-off RRD. Two studies, one with a short-term follow-up and one with a long-term follow-up, were performed, and in both studies the eyes were divided into two groups according to the DMD. In study I, 96 patients were divided into DMD ≤7 days (n = 73) and prolonged DMD more than 7 days (n = 23) with a postoperative follow-up of at least 3 months (mean 43.5 months). In a subgroup analysis, patients were divided into acute DMD ≤3 days (n = 37) and subacute DMD ≧4 days and ≤7 days (n = 36). Study II included 47 patients with a follow-up of at least 5 years (mean 6 years). All patients were divided into(subacute) DMD ≤7 days (n = 36) and (prolonged) DMD of >7 days (n = 11). Additional preoperative predictive factors including DMD, preoperative visual acuity (VA) and patients’ age at the time of the RRD were correlated with the postoperative VA. Results: In study I, the mean final VA was significantly better (0.45) after a DMD of less than or equal to 7 days, compared to patients with a DMD of more than 7 days (0.22; Student’s t test, p = 0.02). VA ≧0.4 was achieved in 68% with a subacute DMD compared to 52% in patients with prolonged DMD (χ2 test, p < 0.001). However, the postoperative VA (0.48 ± 0.09) in eyes with DMD of 1–3 days was similar (0.42 ± 0.07) to eyes with DMD of 4–7 days (Student’s t test, p = 0.455). We divided the 96 patients into 2 groups according to a preoperative VA. Eyes with a preoperative VA ≤0.1 (n = 62) had a significantly lower final VA compared to eyes with a preoperative VA >0.1 (n = 34; Student’s t test, p < 0.001). Patients 75 years of age or younger were more likely to achieve a VA of 0.4 or better after SB surgery than older patients (more than 75 years; χ2 test, p = 0.008). In study II, VA improved (by a mean of 1.60 ± 0.02 lines) during the follow-up period from 0.32 ± 0.08 at the 3-month follow-up to 0.46 ± 0.10 at the 5-year follow-up. Eyes with a subacute DMD had a significantly better VA than eyes with a prolonged DMD (Student’s t test, p = 0.004). Patients aged 75 years or less were more likely to achieve a VA of 0.4 or better than patients older than 75 (χ2 test, p = 0.003). Conclusion: The time point of SB surgery has no statistical impact on the final visual recovery in patients with an acute primary macular-off RRD of less than or equal to 7 days. A delay of SB surgery within this time frame does not contribute to an impaired final visual outcome. There was no evidence, that primary macula-off RRDs are emergencies, which cannot wait for a systemic evaluation of the RRD and surgical t...