Background/Aim: Our purpose was to investigate the anatomic success of scleral buckling surgery for rhegmatogenous retinal detachment. Material and Methods: A total of 524 consecutive patients were retrospectively analysed. Several parameters including the lens status, number of breaks and extent of retinal detachment, preoperative proliferative vitreoretinopathy and refractive errors were examined. The minimum follow-up was 6 months. The primary success rate was defined as anatomic success being stable over a period of at least 6 months after surgery. The secondary success rate was defined as anatomic success after the second intervention if necessary. Besides an analysis over all patients, the patients were grouped according to the severity of the preoperative situation in simple, medium and severe cases. Results: The overall primary anatomic success rate was 84.7% and the secondary success rate 96.4% after 1 initial scleral buckling surgery and 1 additional surgery in case of persisting retinal detachment, and 19.1% of the patients with an initially attached retina after 1 scleral buckling surgery experienced a redetachment in the postoperative course and were successfully treated in 60/85 cases. In phakic patients (n = 359) the primary success rate was 89.7%, whereas in pseudophakic patients (n = 165) a primary success rate of 73.9% was obtained. The primary success was additionally influenced by the extent of the retinal detachment measured in clock hours (p <0.001), undetected holes (p = 0.004), small (p = 0.037) and no gas tamponade (p = 0.021). In simple, medium and severe cases, phakic patients always achieved better anatomic results (89.9, 89.1 and 90.2%) compared to pseudophakic ones (82.5, 70.3 and 36.4%). Conclusion: Scleral buckling is a very good surgical option in phakic patients irrespective of the preoperative severity and simple cases in pseudophakic patients. Scleral buckling represents a surgical technique worth being trained and performed in the light of favourable results especially in phakic eyes. Copyright (C) 2010 S. Karger AG, Basel