AIM: To assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 μm using the inverted internal limiting membrane flap technique. METHODS: This retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 μm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure. RESULTS: Mean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 μm (1280-1480 μm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted. CONCLUSION: The inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.