To report three cases of glial hyper-proliferation after autologous internal limiting membrane (ILM) transplantation in idiopathic large macular holes.

Three eyes with full thickness macular holes >500 µm underwent autologous ILM transplantation. After surgery, the macular hole was closed and foveal contour was U-shaped. Optical coherence tomography revealed long-lasting proliferation of glial cells in the fovea after the hole closure. This glial proliferation continued for 6 months, with improved visual acuity, and bump-like features of the fovea.

Autologous transplantation of ILM effectively induced long-lasting proliferation of glial cells, thereby achieving the closure of large macular holes. However, an abnormality of the foveal contour may develop after the hole closure in some cases.