If a patient is hospitalized for treatment of a retinal detachment, an important issue facing the patient is the question of how to choose a surgical procedure. The surgeon will usually decide on the surgical procedure based on the patient’s condition. So what do doctors base their choice of vitrectomy or scleral buckling on? Extra-scleral buckling is one of the conventional surgical methods for treating retinal detachment, which has a history of nearly 80 years. The surgical method is relatively mature, but the relative indications are relatively limited, usually when the retinal fissure is relatively clear and not very posterior, and the patient has a greater post-operative reaction, as well as post-operative astigmatism, strabismus and other problems. Vitreous surgery uses minimally invasive intraocular vitrectomy, whose full name is transciliary flat three-channel vitrectomy, to remove intraocular lesions through perfusion, illumination, and cutting. Therefore, the relative surgical indications are also wider, and it is becoming the mainstream surgical method for retinal detachment surgery. However, there are differences in the final prognosis of these two methods. My personal experience is that the corrected visual acuity outcomes of patients after scleral buckling surgery are generally better than those of vitrectomy surgery. There are many reasons for this, such as the large amount of intraocular irrigation that passes through the eye during vitrectomy, the very bright light-guiding fibers that illuminate the eye during intraocular surgery, and the effect on intraocular tissue cell physiology after removal of the vitreous, which makes the actual damage to the retina from vitrectomy greater than from scleral buckling. I personally prefer vitrectomy, mainly because vitrectomy allows a more comprehensive investigation of all retinal fissures and allows prophylactic laser treatment of the peripheral retina, while its potentially damaging aspects need to be controlled by the surgeon during the procedure, such as avoiding retinal burns due to prolonged irradiation of key retinal sites (macula) with guided light, planning the surgical steps, reducing surgical time and perfusion impact, proper preservation of the vitreous to prevent other postoperative complications, etc. In fact, in surgery, as long as the surgeon puts the patient’s interests first, rather than simply considering the completion of the surgery as the goal, the patient will be able to achieve a good outcome.