Retinal tacks were historically used in the repair of complex retinal detachment associated with giant retinal tear. The authors describe a patient with retinal detachment associated with giant retinal tear who was treated successfully with pars plana vitrectomy, use of stainless steel retinal tacks, endolaser photocoagulation, and gas-fluid exchange. Twenty-one years after treatment, the retina has remained attached, the tacks are in place, and best-corrected visual acuity is 20/30 in the operated eye. Although retinal tacks are no longer used, this case report suggests that intraocular stainless steel may cause minimal or no retinal toxicity during long-term follow-up.