Purpose <p>To investigate long-term changes in peripapillary retinal nerve fiber layer thickness (RNFLT) after surgery for vitreomacular traction syndrome (VMTS), and to identify prognostic factors for surgical outcomes.</p> Study design <p>Retrospective chart review.</p> Methods <p>This retrospective study included 34 eyes from 34 patients with unilateral VMTS who underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and completed a 12-month follow-up. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and peripapillary RNFLT were measured at baseline and at 1, 3, 6, and 12 months postoperatively using swept-source optical coherence tomography (OCT). Longitudinal changes and baseline predictors of visual outcomes were analyzed.</p> Results <p>BCVA improved significantly from 3 months postoperatively (<i>P</i> &lt; 0.001), while CMT reduction was evident from 1 month (<i>P</i> &lt; 0.001). RNFLT progressively decreased across all quadrants, with early thinning in the inferior sector (<i>P</i> = 0.014). Compared with fellow eyes, operated eyes showed greater temporal RNFLT preoperatively but thinner global and inferior RNFLT at 12 months. Better postoperative BCVA correlated with better baseline BCVA, thinner preoperative CMT, and thicker preoperative inferior RNFLT, although baseline BCVA was the strongest independent predictor.</p> Conclusions <p>VMTS eyes demonstrated progressive RNFLT thinning after surgery, reflecting both resolution of vitreous traction and underlying neuronal vulnerability. Baseline BCVA was the most reliable prognostic factor, while CMT and inferior RNFLT may provide additional insights into surgical outcomes.</p>