The study examined a new surgical technique for treating large macular holes (openings in the center of the retina) larger than 400 micrometers in diameter. The surgical procedure consisted of creating two layers of the internal limiting membrane of the eye, which were inverted to cover the hole, followed by the application of autologous blood (the patient's blood) and gas tamponade. All 21 eyes included in the study (100 percent) achieved complete macular hole closure, with an average hole size of 717.29 micrometers. Visual acuity improved significantly, with a median improvement from 1.70 to 0.82 on the logMAR scale (p < 0.001). During the three-month follow-up, no eye-threatening complications appeared. The authors conclude that this two-layer technique with superior and inferior coverage represents an effective surgical approach for challenging cases of large macular holes, but emphasize the need for further randomized controlled trials to confirm these results.