The authors present “My Way” for Macular Hole surgical approach. Reports in the literature are largely retrospective, making direct comparison of surgical strategies and methods difficult.The authors expose their tips and rationale for surgical approach that they believe is a contribution to improved outcomes.

Tip 1 – Idiopathic Macular Holes are actually secondary to Vitreo Macular Traction (VMT)

Tip 2 – In macular holes secondary to VMT, size (not stage) predicts the result; thus the surgery must be adapted to macular hole size (Small<=250 μm; Medium 250-400 μm; Large 400-650 μm and eXtra Large>650 μm.

Tip 3 – ILM peeling is not harmless and is not necessary for Small Macular Holes (SMH).

Tip 4 – For Medium Macular Holes (MMH) a sequential technique of ILM peeling can reduce retina iatrogenic damage thus reducing the functional sequelae.

Tip 5 – For Large Macular Holes (LMH) the authors use theInverted internal limiting membrane flap technique.

Tip 6 – For failed surgery with postoperative flat-open appearance of macular holes and for eXtra Large Macular Holes (XLMH) an superficial arcuate retinotomy could be tried

Tip7 – For Highly Myopic macular hole with retinoschisis and retinal detachment a vitrectomy with an incomplete ILM peeling around the hole is a choice.

Tip 8 – For highly myopic eyes (axial length > 30mm) when an episcleral macular buckling is judge to be necessary, an modification of a previous described homemade episcleral macular buckles, were the Titanium microplate is involved not with a silicone sponge but with fascia lata, can increase long term toleranceand reduce long term related complications.

Tip 9 – In any case avoid fluid contact with the Hole.

Tip 10 -Expect the unexpected.