Pneumatic retinopexy, a term introduced by Hilton in 1985, describes a recently revised and modified operation used for primary rhegmatogenous retinal reattachment. A gas bubble is injected into the vitreous cavity and the patient positioned so that the bubble closes the retinal break, permitting resorption of subretinal fluid. A chorioretinal adhesion formed around the break secures the retina in place. The history of pneumatic retinopexy is presented as well as recent studies on the subject. Characteristics of intraocular gases are reviewed. A protocol is described for pneumatic repair of complex retinal detachments. Patient selection and surgical techniques are recommended. Pneumatic retinopexy is compared to other retinal reattachment techniques and controversial issues are discussed.