To determine the long- term efficacy of indocyanine green (ICG)- assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. Retrospective, interventional, noncomparative case series. One hundred twenty- one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG- assisted macular hole repair during the period of August 1999 to January 2003. All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5% ) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long- acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks. Long- term postoperative anatomic results, visual acuity (VA), and complications. Patients were observed postoperatively for an average of 26 months (range, 12- 53). Anatomic closure of the macular hole was achieved in 118 eyes (98% ) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by< 2 lines in 116 eyes (96% ). Mean visual improvement after surgery was 6 lines (range, 0- 14), and 96 eyes (79% ) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG. Long- term follow- up of patients who underwent ICG- assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results. To determine the long-term efficacy of indocyanine green (ICG) - assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. Retrospective, interventional, noncomparative case series. One hundred twenty- one eyes of 114 patients with stage 2, 3 , or 4 idiopathic macular holes that underwent ICG-assisted macular hole repair during the period of August 1999 to January 2003. All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long- acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks. postoperative anatomic results, visual acuity (VA), and complications. Patients were observed postoperatively for an average of 26 months (range, 12-53). Anatomic closure of the macular hole was achieved in 118 eyes ( 98%) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by Mean visual improvement after surgery was 6 lines (range, 0- 14), and 96 eyes (79%) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG. Long-term follow-up of patients who underwent ICG-assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.