PURPOSE: To determine whether scleral buckle placement at the time of primary repair of open-globe injury of the posterior segment is beneficial. DESIGN: Retrospective, comparative, nonrandomized interventional study. PARTICIPANTS: One hundred twenty-five open-globe injuries treated at the Duke University Medical Center from June 1980 to May 1997. METHODS: Open-globe injuries were classified with the Open-globe Injury Classification. Eyes that had zone 2 and 3 injuries that had a primary buckle placed were compared with those that did not. MAIN OUTCOME MEASURES: Subsequent retinal detachment, visual outcome, and need for subsequent scleral buckling. RESULTS: The rate of retinal detachment and the visual outcome were similar in the two groups. More than half of those who did not have a primary buckle placed had subsequent scleral buckling surgery. CONCLUSIONS: Many open-globe injuries of the posterior segment require eventual scleral buckle. There may be a role for placement of a scleral buckle at the time of primary repair.