PurposeTo determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes. DesignProspective, interventional case series. Patient and MethodsTen eyes of 10 consecutive patients who underwent autologous transplantation of the ILM for the treatment of refractory macular holes were studied. The primary diseases in these patients were large idiopathic macular holes that had existed for more than one year (4 eyes), a traumatic macular hole (1 eye), myopic foveoschisis (2 eyes), foveoschisis due to pit-macular syndrome (2 eyes) and proliferative diabetic retinopathy (1 eye). Apart from the 5 eyes with idiopathic or traumatic macular holes, macular holes had developed in the other five eyes after initial vitrectomies with ILM removal. In all eyes, regular macular hole surgery had failed to achieve closure. The main outcome measures used in this study were macular hole closure and best-corrected visual acuity (BCVA). ResultsMacular holes were successfully closed in 9 eyes (90%) after autologous transplantation of the ILM. The postoperative BCVAs were significantly better than the preoperative BCVAs (p = 0.007, paired t-test). Postoperative BCVAs improved by more than 0.2 logMAR in 8 eyes (80%) and were unchanged in 2 eyes (20%). ConclusionsAlthough this is a pilot study, the results suggest that autologous transplantation of the ILM may contribute to improved anatomical and visual outcomes in the treatment of refractory macular holes and warrant further investigation.