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Background and Objectives: This study aims to compare the outcomes of pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Materials and Methods: A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. An electronic search was conducted identifying six comparative studies of PnR versus PPV for RRD enrolling 1,061 patients. The primary outcome was visual acuity (VA). Anatomical success and complications were the secondary outcomes. Results: No statistically significant difference was observed in VA between the groups. There was a statistically significant difference in the odds of re-attachment favoring PPV over PnR (odds ratio [OR] = 0.29, P < 0.00001). No statistically significant difference was found in final anatomical success (OR = 1.00, P = 1.00) and the development of cataracts (OR = 0.34, P = 0.61). Other complications, including retinal tears and postoperative proliferative vitreoretinopathy, were more frequently reported in the PnR group. Conclusion: PPV has a higher rate of primary reattachment compared to PnR for treating RRD with comparable final anatomical success, complications, and VA outcomes. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:xx–xx.]