The Inverted ILM Flap Technique is a method that I developed for the treatment of macular holes. Postoperative spectral OCT images show that the inverted ILM flap serves as a scaffold for tissue migration or proliferation towards the centre of the macular hole to close the macular hole. The method continues to prove successful in large macular holes, holes of long duration and in myopic macular holes. Initially, when developing the Inverted ILM Flap Technique, I removed ILM from all sides up to the margins of the hole. I would then place ILM, connected with retina tissue around the hole, over the hole in a multi-layered fashion. I was aware that there was the potential for damage occurring to the nerve fibre layer or retina resulting haemorrhages caused when peeling ILM and looked for a way to avoid this. When I later realized that ILM removal in papillomacular bundle is not needed, I felt that a flap coming only from the temporal side ought to suffice and should create an equally effective scaffold for closure of the hole. I modified the technique accordingly and continued to receive hole closure and successful results without risk to the NFL or retina. Using the new method, I found that in some cases it was difficult to create a single large flap so I made two smaller flaps and put them in multi-layered fashion, gently massaging the flaps on the surface of retina to secure the flap position. This led to my being able to work with smaller and smaller flaps as my experience grew. I routinely use Blue staining and flat contact lens for ILM flap preparation as the staining improves visualization of the ILM which gives me greater precision when positioning the flap. Green staining without flat contact lens should also give great visualization. During fluid air exchange it is important to avoid touching the flap with flute needle. I take great care to position the flute needle opposite the flap in order to produce a stream of fluid coming to the flute needle as this secures the position of flap. I always employ an air tamponade only except in reoperation cases where sometimes silicone oil allows more precise control. Three days face-down positioning is my standard recommendation. What size should the flap be? From experience, I am now satisfied that the flap size needs to be only slightly larger than the hole. Ensuring that the flap is securely in place is essential to success.