Rhegmatogenous retinal detachment (RD) surgery is the most common indication for vitreoretinal surgery. Pars plana vitrectomy (PPV) and scleral buckle (SB) are the most commonly used techniques, with the proportion of patients undergoing SB significantly decreased over the last decade in the US and worldwide. There is agreement that PPV is the surgery of choice for complex RD and in pseudopakic eyes. However, SB remains a valid option for treatment of RD in young phakic patients where the detachment is caused by round holes or dialyses in the absence of posterior vitreous detachment (PVD) particularly as despite the advancement in PPV surgery techniques, contemporary studies have shown no difference in anatomical or functional success rate over SB in treatment of non-complex RD. In those cases, SB is more time and cost effective and is associated with less risk postoperative complications including a lower risk of cataract. In this presentation, we aim to reflect on our experience in the management of RD and present data on practice pattern and single surgery success rate for both PPV and SB from the UK National Ophthalmology Database. We will refer to the results of the EVRS retinal detachment studies to back up our view that the pathophysiology and morphology of RD and the state of crystalline lens should be taken in account when planning the technique of RD surgery and that training of vitreoretinal fellows to perform SB needs to continue.

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Ahmed Sallam