Seventy-six consecutive patients with total rhegmatogenous retinal detachments and severe proliferative vitreoretinopathy underwent combined pars plana vitrectomy, lensectomy, panretinal photocoagulation, perfluoropropane gas (C3F8)/fluid exchange, and scleral buckling. Sixty-two (82%) of the patients had successful, sustained (greater than 12 months) posterior retinal reattachments at last examination. Of these 62 patients, 40 (65%) had complete retinal attachment, with no evidence of regrowth of periretinal membranes or redetachments following the initial procedure. In the remaining 22 cases with successful reattachment of the retina posterior to the equator, partial peripheral retinal detachments were observed. In 16 of the 22 cases, the detachments occurred entirely anterior to the boundary of the previously placed photocoagulation lesions. The posterior retina remained uninvolved, and no further treatment was needed. Reoperation was required in the other six patients to achieve sustained posterior retinal reattachment. Postoperative visual acuity ranged from 20/40 to bare light perception, with 69% of the anatomically successful cases obtaining functional visual acuity (greater than 20/400). Failures were related to reproliferation of fibrous membranes.