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AIMRC), Al Ahsa, Saudi Arabia; 2Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Ophthalmology Division, Prince Mohammed Bin Abdulaziz Hospital, Medina, Saudi Arabia; 4Ophthalmology Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi ArabiaCorrespondence: Omar Al Abdulsalm, Ophthalmology Division, King Abdulaziz Hospital (Ministry of National Guard Health Affairs), King Abdullah International Medical Research Center (KAIMRC), Al Ahsa, Saudi Arabia, Tel +966 504859424, Email [email protected] Purpose: To compare re-vitrectomy versus combined re-vitrectomy with scleral buckling (SB) for pediatric recurrent rhegmatogenous retinal detachment (RRD) following failed primary pars plana vitrectomy (PPV). Methods: This was a retrospective, comparative case series of pediatric patients (under 18 years) who underwent secondary RRD procedures after failed primary PPV. Patients were divided into the re-vitrectomy and the combined re-vitrectomy with SB groups. The primary outcome was the anatomical success rate for each procedure. The secondary outcomes were changes in best-corrected visual acuity (BCVA) and postoperative complications. Results: In the re-vitrectomy group (30 eyes), the final anatomical success rate was 83.3% (25/30) after a mean follow-up of 21.7 + 6.9 months. The final anatomical success rate in the combined re-vitrectomy/SB group (23 eyes) was 73.9% (17/23) after a mean follow-up of 26.5 + 7.7 months. There was no statistically significant difference in the final anatomical success rate (P = 0.41) and the mean change in BCVA (P = 0.37) between the two groups. Even though not statistically significant, the combined re-vitrectomy/SB group had a lower incidence of postoperative complications (P = 0.25). Conclusion: Re-vitrectomy alone provides similar anatomical and functional outcomes to combined re-vitrectomy/SB for pediatric recurrent RRD after failed primary PPV. [ABSTRACT FROM AUTHOR]