Inflammatory detachments are usually treated medically. Some serous detachments, such as choroidal hemangioma, respond to photocoagulation or photodynamic therapy (PDT). Selected traction detachments, such as diabetic or post-traumatic detachments, may be cured with intraocular microsurgery (vitrectomy). Radiation therapy is often used for detachments secondary to metastatic tumors. This chapter is confined to the surgical management of rhegmatogenous detachments with scleral buckling. Alternative methods of repair are discussed in Chapters 8 and 9, and the three techniques are compared in Chapter 10. Controversy exists regarding the details of the surgical technique, but surgeons generally agree on the three basic steps in closing retinal breaks and reattaching the retina:… 1. Conducting thorough preoperative and intraoperative 1. examinations with the goal of locating all retinal breaks and assessing any vitreous traction on the retina. 2. Creating a controlled injury to the retinal pigment epithelium and retina to produce a chorioretinal adhesion surrounding all retinal breaks so that intravitreal fluid can no longer reach the subretinal space. 3. Employing an appropriate technique, such as scleral buckling and/or intravitreal gas, to approximate the retinal breaks to the underlying treated retinal pigment epithelium…. If the surgeon follows these basics and applies modern surgical techniques, retinal reattachment may be expected following a single operation in more than 85% of uncomplicated primary detachments, and in more than 95% following additional procedures. The traditional scleral buckle has served very well since the 1950’s. However, more recent developments have produced a more comprehensive menu for retinal reattachment surgery from which the surgeon may select the appropriate procedure for each case. By the turn of the millennium, surveys had demonstrated that scleral buckling alone was no longer the most popular means of repairing uncomplicated primary retinal detachments. Still, it is a valuable technique that is indicated in many situations. Temporary scleral buckling can be performed with scleral infolding, gelatin, or orbital balloon. The term scleral buckling without a qualifying adjective is generally recognized as referring to a “permanent” scleral buckle with the implantation of a foreign material usually made of silicone.