The proponents of primary vitrectomy claim that the final attachment rate after multiple procedures is 99%. In the series that we examined, it was 97%, equal to that of buckling. This is reassuring. They dismiss the morbidity of multiple operations and regard the frequent provocation of cataract as acceptable.

We do not think it is possible to counteract the change in the treatment of retinal detachment. Perhaps market forces will relax, and peer review will return, or maybe new and less morbid methods to attach the retina will be invented. Admittedly, the incidence of second surgery and PVR were beginning to diminish in the most recent of the case series that we examined, and perhaps a way to reduce the incidence of postoperative cataract will develop. If not, maybe in another 50 years, someone will rediscover the scleral buckle.

■ Acknowledgements. This study was supported by The Edward L. Grayson Retinal Research Fund, West Orange, NJ; Señora Salua H. Kuri, Mexico City, Mexico; Caroline H. Newhouse and the New-house Foundation, New York,USA. The authors have no proprietary interest in any of the aspects of this study.

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