AIM: To evaluate the refractive and long-term outcome of eyes filled with silicone oil (SO) undergoing phacoemulsification cataract surgery (PCS). METHODS: This retrospective study evaluated patients with SO tamponade who were scheduled for PCS. RESULTS: Subjects (n=26) were followed for 29.5±13.9mo after cataract surgery. The median spherical equivalent refraction (SER) was +5.3 D [interquartile range (IQR) +2.9 to +6.7] before PCS, and +3.4 D (IQR +2.0 to +4.4) after PCS. Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes (57.7%). In 13 eyes assessment of refraction after SO-removal was possible, and showed a myopic shift of -4.6 D (IQR -2.9 to -7.3) in the SER. After SO removal, 5 of the 13 eyes (38.5%) were within ±1.0 D of the target refraction, while 9 out of the 13 eyes (69.2%) were within ±2.0 D. CONCLUSION: In our study, the refraction after PCS for eyes filled with SO manifested low predictability, as did the myopic shift following SO removal. A significant percentage of the eyes that underwent SO administration required a long-term tamponade.