Twelve macular holes in 12 patients underwent a pars plana vitrectomy and epiretinal membrane resection with intravitreal gas tamponade for repair of their macular holes. The patients had stage Ill macular holes and had previously undergone a normal funduscopic examination within 2 years. The patients have been followed for a mean of 14 months (range 12-18 months) postoperatively. The results show that visual acuity improvements were not seen until at least 6 months after surgery if the hole was closed successfully. Seven holes were closed (58.3%) and all improved their best corrected visual acuity by more than two Snellen lines. In the five eyes that did not demonstrate hole closure (41-6%), one eye improved by two lines as well. The other four eyes remained at their preoperative acuity. One eye developed a dialysis which responded to a fluid air exchange and cryopexy (8.3%). Three eyes developed minimal lenticular opacities during the follow up period (25%). One eye demonstrated an altered perifoveal pigment epithelium perhaps related to intraoperative light toxicity. Macular hole surgery can restore some central acuity even in patients with longstanding holes.