Purpose: To evaluate the efficacy and safety of 25-gauge illumination-aided scleral buckling (SB) combined with hyaluronate injection for the treatment of rhegmatogenous retinal detachment (RRD). Methods: Forty-five cases were included in this retrospective study. Twenty-five cases of the treatment group received SB with the aid of endo-illumination and noncontact wide-angle viewing system combined with hyaluronate injection after subretinal fluid drainage, while 20 cases of the control group received conventional SB with binocular indirect ophthalmoscope combined with air injection. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and complications were observed and recorded. Results: The mean operation duration of the treatment group (42.06 ± 16.77 min) was significantly shorter than that of the control group (50.19 ± 21.61 min, p = 0.042). Only 1 case of the control group underwent a second surgery, and the final reattachment ratios of the 2 groups were both 100%. BCVA improved in both the treatment group (from 0.91 ± 0.79 to 0.42 ± 0.58 logMAR, p < 0.001) and the control group (from 0.82 ± 0.70 to 0.41 ± 0.37 logMAR, p = 0.001). The improvements of BCVA of the treatment group and control group were –0.49 ± 0.38 and –0.42 ± 0.46 logMAR, with no significant difference (p = 0.594). There was no significant difference in IOP and complications between the 2 groups. Conclusions: 25-gauge endo-illumination-aided SB combined with hyaluronate injection was safe and effective for RRD.