Fresh retinal detachments--the role of scleral buckling

Current concepts and methods of scleral buckling for fresh rhegmatogenous retinal detachments are reviewed in the light of alternative or additional approaches to retinal reattachment surgery. Increasingly, in difficult detachments, temporary internal air tamponade is replacing scleral buckling as a means of achieving initial closure of superiorly-located retinal breaks, though buckling often retains a role in thereafter maintaining break-closure by withstanding persisting vitreoretinal traction. Vitrectomy is also being employed more frequently in fresh detachments in order to relieve vitreoretinal traction, remove vitreous opacities and provide extra space for internal gas injection; however, complete relief of traction in the retinal periphery is seldom achievable, thus necessitating scleral buckling.