Introduction <p>To evaluate whether the air−fluid (A−F) exchange procedure should be recommended for silicone oil (SO) removal surgery.</p> Methods <p>Consecutive patients that underwent SO removal with or without A−F exchange were requested to complete a questionnaire regarding the presence of floaters and SO residual scores. The medical records of the patients who completed the questionnaire were also reviewed retrospectively for clinical data including best corrected visual acuity, postoperative detachment rate, and intraocular pressure, etc.</p> Results <p>A total of 124 cases were included, 68 in the A−F (+) group and 56 in the A−F (−). Both groups were similar in demographic data such as age, sex distribution, axial length, and duration of SO tamponade (all <i>P</i> &gt; 0.05). During the process of A−F exchange, a layer of oil film residue can be observed under the microscope, and A−F exchange can remove the residual SO. The ratio of with/without floating in the A−F (−) versus A−F (+) group was 48/8 versus 36/32 (<i>P</i> &lt; 0.01). In addition, the questionnaire survey on the SO residual scores showed a more significant difference in the impact on postoperative visual quality between the two groups.</p> Conclusions <p>A−F exchange can effectively reduce residual SO and is recommended as a routine procedure for SO removal surgery.</p>