Previous studies had reported that primary success rate for GRT treated by 20-gauge PPV using PFCL assistant without scleral buckling can achieve over 90% [
7]. Another case series reported by Kunikata also suggested similar results for the primary success rate of managing GRT via MIVS [
4]. However, treating patients with a rigid inverted retinal flap is relative difficult and retinal tack might make the surgical procedure easier. To date, there’s no similar reports published in Taiwan currently. We performed MIVS for a case of GRT with retinal detachment. To remove the peripheral vitreous completely and release all possible vitreous traction without causing more damage to the retina, we use WAVs and high cutting rate vitrectomy system. Besides, for GRT with large inverted and rigid flap, we use retinal tacks to stabilize the flap in prevention of intraoperative or postoperative retinal slippage. In present case, reattachment was obtained after initial MIVS. The postoperative complication of cataract formation has been developed in this case and no other complications such as subretinal perfluorocarbon, retinal slippage, recurrent retinal detachment, proliferative vitreoretinopathy formation or macular pucker needing additional surgery during follow up period of 19 months. Reviewing the literatures, Ando et al. introduced polyacetal retinal tacks together with conventional 20G vitrectomy for GRT with 81% of patients with retinal total or partial attached. However, MIVS has the advantage of smaller sclerotomy which might reduce the possibility of occurrence of intraoperative iatrogenic retinal breaks, enhance patient’s comfort and postoperative wound recovery. In addition, WAVs can improve the intraoperative field of view and offer better visibility and sharpness image of peripheral retina [
5]. Currently, retinal tack had been abandoned by many surgeons due to unavailability and the concern of safety, we found it might be irreplaceable in cases of GRT with large inverted and rigid flap [
8] and it may cause minimal or no retinal toxicity during as long as 21 years of follow-up [
9]. To our knowledge, this is the first report of managing GRT with MIVS and retinal tacks in Taiwan.