AIM: To identify factors associated with metamorphopsia in patients with rhegmatogenous retinal detachment(RRD)who underwent primary vitrectomy(PPV). METHODS:This retrospective study included 94 patients(94 eyes)who underwent 23G PPV for repair of RRD between January, 2017 and January, 2019. Each patient were examined both eyes preoperatively and postoperatively(at 1, 6, 12mo and last visits). At each time-point, patients received a complete ophthalmological examination, including best corrected visual acuity(BCVA), intraocular pressure, slit-lamp biomicroscopy, optical coherence tomography(OCT), and M-chart examination.RESULTS: One month after surgery, metamorphopsia occurred in 53%(n=50), the mean M value was 0.68±0.28. The metamorphopsia rate differed significantly between macula-off and macula-on RRD(P<0.01). There was significant difference in M-chart among the different time(F=26.442, P<0.01). Univariate analysis demonstrated that the macula status, location of retinal breaks, and disrupted EZ was a risk factor that was significantly associated with metamorphopsia. In multivariate analysis, macula-involving retinal detachment(OR=9.020, 95% CI:1.808-45.011, P=0.007)and disrupted EZ(OR=10.570, 95% CI:2.909-38.400, P<0.01)was a significant predictors of metamorphopsia.CONCLUSION: The metamorphopsia was improved after anatomically successful RRD surgery. Macular involvement retinal detachment and disrupted EZ were more likely to develop metamorphopsia.