Nine patients with acquired immune deficiency syndrome underwent surgery for rhegmatogenous retinal detachments related to cytomegalovirus (CMV) retinitis. The patients were followed for at least 6 months or until death. Two patients with localized peripheral detachments for 3 to 4 clock hours or less initially underwent laser retinopexy. Although in both cases the treatment ultimately failed, one patient maintained 20/20 vision for 5 months. In four patients in whom the retinal detachment was more extensive but could be explained on the basis of a single or multiple well-defined peripheral break(s), a scleral buckle procedure was performed, with anatomic success in three, two of whom maintained 20/40 vision for 7 and 8 months. Six patients with retinal detachments associated with multiple atrophic holes that were not amenable to scleral buckling were treated with pars plana vitrectomy, air-fluid exchange and endolaser, with anatomic success in three; the visual acuity ranged from 20/30 to 20/400. One patient with failed pars plana vitrectomy underwent repeat vitrectomy with long-term internal tamponade by silicone oil, and he regained hand movements vision. We suggest a graduated approach to the management of retinal detachments secondary to CMV retinitis tailored to each patient based on the number and location of the retinal breaks, the extent of the detachment, the extent of necrotic retina and the overall health of the patient.