The purpose of this four year retrospective study was to compare the anatomical and functional outcomes of complicated retinal detachment (RD) surgery by pars plana vitrectomy (PPV) with and without retinotomy. The main outcome measures were primary anatomical success (defined as retinal re-attachment at the final follow-up after a single operation, with or without silicone in situ), final anatomical success, final best-corrected visual acuity (BCVA) and postoperative complications. Baseline characteristics did not differ between the groups, although there was a borderline significant trend for the retinotomy group to be associated with worse pre-surgical ocular pathology. With a mean follow-up of 18 (± 7.8) months, primary anatomical success was achieved in 76.7% (33 of 43) of the retinotomy group eyes vs. 67.8% (40 of 59) of the eyes in the group without retinotomy. Final anatomical success rates for the retinotomy group and no retinotomy group were 100 and 93.2% respectively. The final BCVA was 1.57 LogMAR with retinotomy and 1.38 without retinotomy, an improvement in both groups. The incidence of postoperative complications was similar in the two groups, while the frequency of macular holes was higher in the retinotomy group. A similar degree of improvement in BCVA following both surgeries indicates their similar efficacy and justifies their performance even in complicated eyes in order to improve the patients' quality of life. With neither approach superior to the other, the choice of method should be left to the surgeon.