The combined procedure of pars plana vitrectomy and liquid silicone exchange has been developed for the management of complex retinal detachment. Complete re-attachment was achieved in 88 per cent of eyes with giant retinal breaks and visual improvement occurred in 71 per cent. Macular re-attachment was obtained in 68 per cent of eyes with massive periretinal proliferation (MPP) and visual improvement occurred in 53 per cent. In contrast, in thirteen cases of severe diabetic traction detachment, only four remained attached with visual improvement in one. In seven eyes with severe perforating trauma and retinal detachment, retinal re-attachment was achieved in four and visual improvement in three. We conclude that this technique is indicated in giant retinal breaks, is encouraging in MPP, has a very limited role in the management of diabetic traction detachment, and requires further evaluation in the management of traumatic detachment.