The authors report a retrospective non-randomised control trial that evaluated the efficacy and safety of 25-gauge illumination-aided scleral buckling (SB) combined with hyaluronate injection for the treatment of rhegmatogenous retinal detachment (RRD). Forty-five cases were included in this study. Twenty-five cases of the treatment group received scleral buckling with the aid of endo-illumination and noncontact wide-angle viewing system combined with hyaluronate injection after subretinal fluid drainage, while 20 cases from the control group received conventional scleral buckling with binocular indirect ophthalmoscope combined with air injection. BCVA, IOP and complications were observed and recorded. The mean age of the 45 patients was 34.9 ±12.5 years (range 20-67 years) and 18/45 (40%) were female. The mean follow-up period was 8.4 ±2.8 months (six to 16 months). The final reattachment rates of the two groups were both 100%. At the final follow-up, both the treatment group and control group gained significantly improved BCVA (0.42 ±0.58 and 0.41 ±0.37 logMAR, respectively) compared with preoperative BCVA. Ten eyes of the treatment group and seven of the control group underwent transient elevated IOP, which lowered to normal after using local and general glaucoma medications. Among the 17 eyes, seven were hyaluronate injection cases, five were injected with air and the remaining five had no injection, which showed no significant difference in different tamponades (p=0.088). At the end of follow-up, the IOP of all patients from either group was no higher than 21mmHg without using any glaucoma medication or undergoing glaucoma surgery; the mean IOP of the two groups were 14.01 ±2.64 and 14.59 ±2.69mmHg, with no significant difference compared with preoperative values (p=0.103 and p=0.085, respectively). There was no significant difference in final IOP and complications between the two groups. The authors concluded that 25-gauge endo-illumination-aided scleral buckling combined with hyaluronate injection was safe and effective treatment for rhegmatogenous retinal detachment. The use of endo-illumination and the noncontact wide angle viewing system resulted in a clearer view of the fundus and it became easier to confirm the location of retinal tears. The improved procedure had a shorter mean operation duration than conventional surgery. The surgical microscope enabled video recording for further training and review.