Large, persistent or chronic macular holes still represent a surgical challenge, which can be addressed using the presented surgical technique. A subretinal injection of balanced salt solution (BSS) at the posterior pole of the macular region is performed during transconjunctival pars plana vitrectomy in order to induce an elevation of the neurosensory retina in the macular region. The hole is then attenuated during fluid-air exchange, followed by a gas or silicone oil tamponade. The presented technique appears to be useful for large and persistent macular holes, which are not suitable for conventional macular hole surgery. The exact patient information on the potential outcome of surgery in this specific group of patients seems particularly important.