Scleral buckling surgery is another good option for repair of many retinal detachments. In scleral buckling surgery a buckling element, usually a piece of silicone, is sutured to the sclera (the outer wall of the eye) in such a way as to indent the wall of the eye. This indentation reduces the traction that is created by the vitreous pulling on the retinal tear, thereby allowing the tear to close. Cryotherapy is usually used in this procedure as well, to create a permanent seal surrounding the retinal tear. The fluid which has collected under the retina is either surgically removed or is allowed to spontaneously reabsorb. Sometimes a gas bubble will also be injected into the vitreous cavity as part of this procedure. Scleral buckling surgery is performed in an operating room. It is frequently done under local anesthesia and the patient will usually return home the same day as the surgery.

Sometimes, particularly in more complicated retinal detachments; it may be preferable or necessary to remove the vitreous in order to reattach the retina. This procedure is called a vitrectomy (also called pars plana vitrectomy). Vitrectomy may be used in combination with the other techniques already described. During vitrectomy surgery, small incisions are made through the sclera, which allow microsurgical instruments to be introduced into the vitreous. The vitreous, along with any scar tissue, which may also be present, is removed. In this way the traction on the retina is eliminated. The fluid that has collected under the retina is surgically removed. The vitreous cavity is then usually filled with a gas bubble. Sometimes in more complicated retinal detachments the vitreous cavity may instead be filled with silicone oil. The retina tear is surrounded with laser photocoagulation. A scleral buckle may be placed in conjunction with vitrectomy. Vitrectomy surgery is performed in an operating room. The patient will usually return home the same day as the surgery.