Pneumatic retinopexy (PR) was first introduced in the mid-1980s, independently by Dominguez1 and by Hilton and Grizzard,2 for the repair of rhegmatogenous retinal detachment (RRD). It consists of retinopexy of retinal breaks with intravitreal injection of gas into the vitreous cavity followed by postoperative positioning. Indications for PR, as described by Tornambe and Hilton3 in the multicenter, randomized, controlled clinical trial comparing PR with scleral buckling, included the presence of 1 or more retinal breaks within 1 clock-hour of the retinal arc in the upper two-thirds of the retina and sufficiently clear media to rule out the presence of other retinal breaks. Later on, indications for surgery have expanded to include multiple breaks in multiple quadrants, larger retinal breaks, and moderate proliferative vitreoretinopathy (PVR).4,5 With time, owing to its minimally invasive nature, cost-effectiveness, and relatively technical simplicity, PR has become commonly used in clinical practice. However, alongside its widespread popularity, the reported complications associated with PR have also grown.6- 13 In addition, PR was reported to be less efficient in specific conditions, including in nonphakic eyes, in eyes with poor preoperative visual acuity (VA), in large detachments, and in cases with multiple retinal breaks.7,13- 15 Furthermore, a broad range of anatomical success rates of 53% to 100% after a single PR procedure were reported.12 Together these reservations gave rise to a heated debate between those in favor and those against PR for RRD. The objective of this study was to investigate, in a relatively large case-series, the risk factors for failure and outcomes of PR surgery for the repair of primary RRD, with special attention to differences in outcomes between successful cases and failed cases that underwent only 1 additional reattachment operation.