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Principles of rhegmatogenous retinal detachment (RRD) surgical management remains the same than 40 years ago: finding all retinal breaks, sealing the retinal breaks by creating a chorioretinal scar around the breaks («retinopexy»), drainage of subretinal fluid in some cases, and relief of vitreoretinal traction. To achieve these purposes, we can use external techniques (scleral buckling), internal ones (vitrectomy), or a mixed of both (pneumatic retinopexy).

Recently, with rapid advances in instrumentation and improved success rates of vitrectomy, there has been a growing trend towards primary vitrectomy for RRD. This over use of primary vitrectomy in RRD, if it seems fashionable, is justified neither by clinical findings nor by controlled trials. Moreover, scleral buckling techniques are no more teached to young retinal surgeons, decreasing mathematically scleral buckling indications. External techniques for treating RRD could disappeared, not because unfavourable evidences in controlled clinical trials, but just because it would not follow the trends!

Surgical strategy in RRD is based on preoperative clinical exam and peroperative evaluation rather than trends. I will present my way in front of a RRD in a decision-making tree form where scleral buckling techniques are still present because of their usefullness and efficiency.