We performed initial vitreoretinal surgery on 81 eyes with rhegmatogenous retinal detachments complicated by severe proliferative vitreoretinopathy. Of 81 eyes, 68 (84%) had undergone previous scleral buckling. We performed vitreous base dissection on all 18 eyes (22%) that had anterior proliferative vitreoretinopathy. With one vitreoretinal operation, 66 of 81 eyes (81%) remained totally reattached. The main cause of initial anatomic failure and reoperation was either new or recurrent proliferation at the vitreous base. With additional vitreoretinal surgery and after a mean follow-up period of 19 months, 73 of 81 retinas (90%) were totally reattached. The final causes of anatomic failure were anterior proliferative vitreoretinopathy and proliferation from relaxing retinotomies. Of the 73 successfully reattached eyes, 62 (85%) had postoperative visual acuity of 5/200 or better.