Scleral buckling alone used to treat retinal detachment with massive periretinal proliferation resulted in an overall cure rate of 34.7%. The success rate declined with increasing severity of massive periretinal proliferation. A detailed anatomic classification for massive periretinal proliferation was used to define the configuration of the eyes undergoing operation. We currently recommend scleral buckling alone for moderate degrees of massive periretinal proliferation; we reserve vitrectomy with preretinal membrane removal and scleral buckling for more advanced cases.