Long lasting macular holes happen in clinical practice and they remain a surgical challenge. EVRS MH study performed in 2013 revealed that failure rate is 4 times higher in long lasting macular holes, so they should be operated as soon as possible. But what to do if the macular hole was not operated at the early stage? How to perform surgery to minimalize the failure rate? There are some controversies as far as triamcinolone use during macular hole surgery. Indeed, EVRS study did not confirm the triamcinolone influence on macular hole closure rate.

Reverted flap technique was also proposed by Jerzy Nawrocki especially for “difficult holes”. This presentations is to show my technique of vitreous staining and ILM peeling in long-standing (more than a year) macular holes.