Background: Pediatric optic disc pit maculopathy (ODPM) is a rare condition that threatens children's visual development. Current treatments, such as pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, are effective but controversial in pediatric cases due to potential complications. The efficacy and safety of ILM-sparing vitrectomy in pediatric ODPM patients remain underexplored. This case series evaluates the outcomes of ILM-sparing vitrectomy in pediatric ODPM patients, providing insights into its potential benefits and complications. Case Description: This retrospective study included four pediatric patients with ODPM who underwent ILM-sparing vitrectomy. The average patient age was 7.75 +/- 3.77 years (range 5-13 years). Preoperatively, all four eyes had retinal detachment involving the central macula. The mean follow-up duration was 29.75 +/- 4.57 months (range 25-35 months). Preoperative best-corrected visual acuity (BCVA) was LogMAR 1.18 +/- 0.67 (range 0.3-1.7). Twelve months postoperatively, BCVA improved to LogMAR 0.1 +/- 0.08 (range 0.1-0.2) and remained stable between 12 and 24 months. Central macular thickness (CMT) also improved from a mean preoperative CMT of 969.75 +/- 56.28 to 265.25 +/- 34.35 mu m at 24 months postoperatively. All four eyes achieved total macular attachment at 12 months postoperatively. Two patients experienced transient postoperative high intraocular pressure, but no recurrent subretinal fluid (SRF) or full-thickness macular holes were observed during follow-up. Conclusions: ILM-sparing vitrectomy appears to be an effective treatment for pediatric ODPM, resolving maculopathies and restoring BCVA with minimal complications. This approach may offer a safer alternative to traditional ILM peeling in pediatric cases. However, larger studies with extended follow-up are needed to confirm these findings and further explore their clinical impact.