Purpose: To observe the complications after heavy silicone oil (HSO) tamponade in complicated retinal detachment. Methods: Thirty-three eyes of 33 patients with complicated retinal detachment were included in this retrospective study. Vitrectomy and HSO tamponade were performed in all patients. Other surgical procedures were performed as necessary. The main outcome measures included retinal reattachment, visual acuity, intraocular pressure, intraocular inflammation, lens opacity, and HSO emulsification. Results: The patients were followed up for 3 months to 24 months (average, 8.1 +/- 5.3 months). Retinal reattachment was achieved in 29 eyes (87.9%) with a first surgery and in 33 eyes (100%) with a second surgery. In all 33 eyes, HSO had been removed and the visual acuity was improved. Short-term (within 2 weeks after operations) complications included temporarily increased intraocular pressure and mild inflammation in the anterior chamber. Major long-term complications included cataract (100%) and HSO emulsification (42.4%). Other long-term complications included ocular hypertension (12.1%), retinal detachment and proliferative vitreoretinopathy (12.1%), and low intraocular pressure (9.1%). Conclusion: Heavy silicone oil tamponade is safe and effective to treat complicated retinal detachment. The most common complications are cataract and HSO emulsification. RETINA 31: 547-552, 2011