Macular hole is a foveal full thickness rounded defect.(1) affecting the central vision.(2) Patients usually complains of metamorphopsia and decreased vision. ILM can halter cellular proliferation such as the proliferation of epi macular glial and Müller cell within the hole and throughout the ILM surface leading to macular hole enlargement, thickening, and distortion, therefore the presentation of surgical ILM peel caused a significant enhancement in the outcomes of macular hole surgeries, accordingly, it became a routine practice in MH surgeries, yet, in the beginning there was no efficient treatment with the standard procedure for MHs with large diameters >400 mm, MHs from a long duration, and MHs secondary to uveitis ,severe myopia, proliferative vitreoretinopathy, and ocular trauma, failure of hole closure, till, in 2010, when Michalowski pronounced the inverted ILM flap method for large idiopathic MHs, this technique was based on not removing the ILM but instead positioning it into the MH, thus, facilitating the MH closure due to the induction of Müller cell gliosis, later, various studies show the significantly improved anatomical and visual outcomes in patients with macular holes who underwent this surgery.(3)