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This is a video shared by Dr. Mario Gutierrez from Guatemala City - Guatemala This is a case of a large macular hole in a patient recently treated with scleral buckle for rhegmatogenous retinal detachment. For this procedure, it was programmed pars plana vitrectomy with ILM peeling. The technique chosen by the surgeon was the inverted ILM flap technique. There are some variations on this technique regarding the position of the flap. In the technique first described, the internal limiting membrane was peeled leaving it attached to all the circumference of the macular hole, and at the end of the surgery, the flap was inverted to fill the hole. After finishing the peeling, due to the mobility of the Internal limiting membrane, it is difficult positioning the flap into the macular hole. So, the surgeon injected a perfluorocarbon liquid bubble at the posterior pole to stabilize the flap and help to keep it inside the hole. In the end of the surgery the vitreous base was review and endolaser was performed in inferior breaks and then fluid air exchange are made. The inverted ILM flap was kept stable in the correct position even after PFCL removal. Video: Mario Gutierrez MD Guatemala City - Guatemala Edition: Filipe Lucatto MD Juliana Prazeres MD Salvador - Brazil