Comparative Outcomes of Single-Stage Versus Two-Stage Silicone Oil Removal With Phacoemulsification and Intraocular Lens Implantation

Purpose: To compare visual, refractive, and surgical outcomes between single-stage (concurrent) and 2-stage (sequential) silicone oil removal with phacoemulsification and intraocular lens implantation in patients previously managed for retinal detachment. Methods: This retrospective case series included patients who underwent silicone oil removal with cataract extraction between January 2018 and October 2024 at Bascom Palmer Eye Institute. Outcomes evaluated included best-corrected visual acuity (BCVA), spherical equivalent, and refractive accuracy based on median prediction error and mean absolute error. Results: A total of 272 eyes were analyzed: 26 in the sequential group (mean ± SD age, 48.7 ± 12.9 years; 54% male) and 246 in the concurrent group (mean ± SD age, 52.9 ± 12.2 years; 61% male). BCVA improved in both groups, with final median BCVAs of 0.53 logMAR in the sequential group and 0.71 logMAR in the concurrent group ( P = .064). Spherical equivalent was similar between groups ( P = .843), but the sequential group had better refractive predictability with a lower median prediction error compared with the concurrent group (median –0.26 diopters vs 0.21 diopters; P = .008). The mean absolute error was comparable between groups ( P = .662). Subgroup analysis and multivariate regression revealed no significant predictors of outcomes. Cystoid macular edema occurred in 6 eyes in the sequential group (23%) and 7 eyes in the concurrent group (3%); glaucoma or elevated intraocular pressure occurred in 6 eyes in the sequential group (23%) and 16 eyes in the concurrent group (7%) ( P = .013). Conclusions: Both approaches resulted in improved outcomes, with the sequential method providing superior refractive predictability with less hyperopic error and a trend toward better final visual acuity, suggesting a potential advantage for staged procedures in enhancing surgical precision. However, the sequential method was also associated with higher postoperative complication rates, underscoring the need to balance refractive precision with surgical safety when selecting between staged and combined procedures.