I present what, in my opinion, is the optimal technique of managing primary simple retinal breaks and retinal detachment. For the preoperative examination, I recommend indirect stereoscopic ophthalmoscopy with scleral depression. The macula and suspected small peripheral breaks are studied with the biomicroscope and a three-mirror contact lens. Retinal breaks without retinal detachment are treated with cryotherapy if they are located anteriorly; with laser photocoagulation if they are posterior. Breaks with frank detachment can be treated with Lincoff's balloon, a procedure I prefer over pneumatic retinopexy. Multiple retinal breaks and those associated with fairly extensive chorioretinal degeneration are best treated with a permanent scleral buckling, the various modalities of which, along with their indications, I discuss in some detail.
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