To determine whether scleral buckle placement at the time of primary repair of open-globe injury of the posterior segment is beneficial.Retrospective, comparative, nonrandomized interventional study.One hundred twenty-five open-globe injuries treated at the Duke University Medical Center from June 1980 to May 1997.Open-globe injuries were classified with the Open-globe Injury Classification. Eyes that had zone 2 and 3 injuries that had a primary buckle placed were compared with those that did not.Subsequent retinal detachment, visual outcome, and need for subsequent scleral buckling.The rate of retinal detachment and the visual outcome were similar in the two groups. More than half of those who did not have a primary buckle placed had subsequent scleral buckling surgery.Many open-globe injuries of the posterior segment require eventual scleral buckle. There may be a role for placement of a scleral buckle at the time of primary repair.