PURPOSE: To determine the incidence, prognostic factors and management of macular edema (ME) associated with silicone oil (SO) tamponade. METHODS: This retrospective, comparative, observational study included patients who underwent pars plana vitrectomy (PPV) and SO tamponade for rhegmatogenous retinal detachment (RRD) or persistent full-thickness macular hole (FTMH). Demographic data, clinical characteristics, and OCT findings were analyzed, focusing on the presence of ME. Propensity score matching was performed to control for confounding variables, and multivariable logistic regression identified predictive factors for ME development. RESULTS: A total of 114 eyes of 112 patients was included. ME developed in 64 out of 114 eyes (56.1%) during SO tamponade. The mean duration of SO tamponade was significantly longer in the ME group (665 days, SD 580) compared to the non-ME group (239 days, SD 196) (p<
0.0001). PVR was present in 74 eyes (71.4%) in the RRD group. Additionally, 49% of eyes that did not develop ME during SO tamponade experienced ME after SO removal, with an average CMT increase of 39 μm (SD 9). Multivariable logistic regression analysis identified retinectomy (62% in the ME group vs. 29% in the non-ME group, p=0.0013) and longer duration of SO tamponade (p<
0.0001) was associated with ME. CONCLUSIONS: This study demonstrates a high incidence of ME in eyes with SO tamponade. Prolonged SO tamponade and retinectomy were significant predictors of ME development. These findings emphasize the importance of careful monitoring and timely SO removal to minimize ME-related complications.