Methods: A 72-year-old male patient presented with a 3-month history of decreased vision in his right eye. Visual acuity in the right eye was 20/200 on the Snellen chart. Fundus examination revealed a macular hole in the right eye. The patient underwent a 25-Gauge pars plana vitrectomy with the temporal inverted flap technique. At the 1-month postoperative OCT evaluation, the flap had properly covered the hole, but the macular hole remained open and the foveal defect persisted. The ILM flap formed a dome-like structure over the hole, with significant fluid accumulation underneath. Three months after the first surgery, a second surgical intervention was planned. The existing flap was folded into its normal position, and the hole was closed again without modifying the flap configuration (flap repositioning).

Results: On postoperative day 12, OCT confirmed that the macular hole had closed and the foveal contour had returned to normal. At the 1-month follow-up, the patient?s visual acuity improved to 20/50 on the Snellen chart, and by the 3rd month, it was recorded as 20/40.

Conclusion: This case demonstrates that in macular hole cases treated with the inverted ILM flap technique, repositioning the inverted flap can increase surgical success when anatomical closure is not achieved. Keywords : macular hole, inverted flap technique, persistent macular hole, vitrectomy, flap repositioning