AIM:To evaluate the efficacy of autologous heparinized whole blood in assisting internal limiting membrane (ILM) peeling by coating the ILM for idiopathic macular hole (IMH) repair. METHODS:Six patients (7 eyes) with IMH were enrolled in this study. After standard vitrectomy, autologous heparinized whole blood was applied to cover the macula and to coat the surface of the macular area in the fluid-filled vitreous cavity. The redundant blood was removed and only a very thin film of blood was left on the macular area. The blood-coated ILM was removed by forceps. RESULTS:All 7 eyes in 6 patients completed at least 3 months of follow-up. The ILM were coated by autologous heparinized whole blood, removed without difficulty. The whole blood highlighted the contrast of the coated and non-coated areas during the ILM peeling procedure. The IMH were closed in all surgical eyes with a single surgery. No toxic fundus changes were observed during follow-up. CONCLUSION:Autologous heparinized whole blood coat the ILM and facilitate visibility during ILM peeling. Autologous heparinized whole blood is a cost-effective and useful tool for assisting IMH surgery.