Fifty cases of retinal detachment with poor prognosis were treated with a 360° scleral buckling procedure, as the initial operation here, using silicone implant, encircling silicone element, and diathermy or cryoapplications. Successful reattachment of the retina was achieved in 84% of the cases. Serious postoperative complications occurred in 14% of the cases, and included large intraocular hemorrhage, anterior segment necrosis, and implant infection. The procedure is indicated in a limited number of cases according to the criteria outlined in this paper and because of the relatively high incidence and severity of postoperative complications should be confined to the treatment of carefully selected complex retinal detachments.