Since the first vitrectomy surgery was used for treatment of vitreoretinal diseases, surgical techniques and instrumentation have been rapidly improved in the past decades. However, there are complicated vitreoretinal diseases that cannot be successfully treated, even with state-of-the-art surgeries. The outcomes of some complicated cases are still poor due to different reasons and debates still remain in some areas regarding what are the best treatments. There is still a lack of full understanding on many complicated vitreoretinal diseases, such as the molecular basis of proliferative vitreoretinopathy (PVR), the role of scleral buckling (SB) in the management of rhegmatogenous retinal detachment (RRD), the optimal surgical consideration for pediatric RD, and the possibility of surgical management for various retinal degenerations and congenital retinal anomalies. This review discusses the current understandings of some complicated vitreoretinal diseases.