The initial surgery is one of the most important factors influencing the anatomic and functional outcome of retinal detachment surgery. With the continual modifications in vitrectomy techniques, the strategy in primary vitrectomy surgery is also changing. Recent developments are the use of 25- and 23-gauge trocar systems and new surgical techniques without the use of perfluorcarbons or gas or silicone oil tamponade. In addition, heavy silicone oils are now entering routine clinical use, especially for proliferative vitreoretinopathy (PVR) redetachments of the lower fundus periphery. Regarding adjunct pharmacologic therapy, daunorubicin and 5-fluorouracil/low molecular weight heparin have been found to improve the results of patients with PVR or at risk for PVR.