AIM: To report the refractive and surgical outcomes of scleral buckling (SB) with or without pars plana vitrectomy (PPV) in patients with pseudophakic rhegmatogenous retinal detachment (PRRD). METHODS: A consecutive case series of patients with pseudophakia who underwent retinal detachment (RD) surgery was enrolled. The SB procedures were selected to initially treat primary pseudophakic PRRDs and SB-PPV for more complex cases, according to preoperative findings. Eyes with anterior chamber intraocular lens, proliferative vitreoretinopathy anterior to equator, previous invasive glaucoma surgery, severe degenerative myopia or macular hole, and <6mo follow-up were excluded from outcomes analysis. The primary clinical outcome measures were the single surgery anatomic success (SSAS) and final surgery anatomic success (FSAS) rates. Secondary outcome measures were postoperative visual acuity and refractive error. RESULTS: A total of 81 consecutive patients (81 eyes) were enrolled for analysis, comprising 66 (81%) men and 15 (19%) women with a mean age of 58y (range, 33-86y) and the mean final follow-up period was 21.0±19.6mo. A total of 62 PRRDs (n=62; 76.5%) were repaired with an initial SB, and 19 PRRDs (n=19; 23.5%) were repaired with a combined SB-PPV. The SSAS and FSAS rates were 92.6% (75/81) and 100% (81/81), respectively. All initial failures had retinal reattachment after the secondary PPV. The mean final postoperative best-corrected visual acuity (BCVA) was 0.42±0.33 logMAR (visual acuity 20/55) and final mean refractive error was -1.48±1.40 diopters. The patients who underwent initially SB-PPV had a significantly longer duration of RD and a higher giant retinal tear rate (P<0.05) preoperatively. SSAS was 56/62 (90.3%) and 19/19 (100%), and the mean postoperative refractive error was -1.30±1.32 D and -1.53±1.38 D for the patients in the SB and SB-PPV groups, respectively. There was no statistically significant difference for those who had SSAS and postoperative refractive errors between the 2 groups. The postoperative BCVAs of the patients with SSAS were not significantly better in the SB group (median, 20/40) than in the SB-PPV group (median 20/50). In the SB group, patients with macula-on had better visual acuity postoperatively than patients with macula-off (P=0.000). CONCLUSION: The initial surgical procedures of SB with or without PPV according to the preoperative findings achieve a high reattachment rate and an acceptable refractive error for primary pseudophakic RRD management.