PURPOSE: To report the technique and long-term outcomes of patients with giant retinal tear-associated retinal detachment treated with pneumatic retinopexy (PnR). METHODS: Retrospective cohort study. All patients presenting with giant retinal tear-associated retinal detachment with tears in the superior ten-clock hours who underwent primary PnR were included in this study . RESULTS: Thirty-one patients were included in the study. Of these, 61.2% (19 of 31) achieved primary reattachment rate (PARR) with PnR at 3 months and 58.0% (18 of 31) at the final follow-up. Patients included in this study had a median follow-up of 24 months (interquartile range 46.5 months). The absence of retinal tears elsewhere at baseline was associated with a final PARR of 80% (16 of 20) ( P = 0.007). Thirteen eyes required pars plana vitrectomy after a failed PnR. Two eyes required the intraoperative use of perfluorocarbon liquids. No eyes required silicone oil. Visual acuity improved significantly from baseline to the last follow-up. Final anatomical reattachment rate was 100% (31 of 31). CONCLUSION: For selected cases of giant retinal tear associated retinal detachments affecting the superior ten-clock hours, PnR could be a possible treatment option when patients consent to extra visits and the surgeon has substantial expertise. When lacking this extensive experience and comfort with PnR, pars plana vitrectomy remains the treatment that is most likely to result in a primary anatomical reattachment. Although this study provides guidance on PnR technique for giant retinal tear associated retinal detachments, it is essential to note that the reported PARR may be contingent on the expertise of the surgeon/center, and the authors recommend that those new to PnR first gain substantial experience in cases meeting clinical trial criteria.