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PURPOSE To evaluate the efficacy of repeat pars-plana vitrectomy (PPV) and gas tamponade for persistent macular holes (MH), especially looking at predictive value of OCT parameters in revisional surgery METHODS:: Retrospective, non-randomised interventional case series of consecutive patients with persistent MH that underwent revisional PPV and gas tamponade. The primary outcome measure was anatomical closure of the MH after revisional surgery. The secondary outcome measure was functional outcome of the MH closure based on BCVA. The changes of minimum linear diameter (MLD) and macular hole index (MHI) after the primary surgery were evaluated to see if they were prognostic markers of success for the revisional surgery. RESULTS Twenty-seven patients with a persistent MH after primary macular hole surgery were identified, all of whom underwent a second operation with PPV and gas tamponade with an ILM peel extension in 20 cases. The MH closure rate after revisonal surgery was 89% (24/27). Twenty-two cases were included in the OCT analysis, of which 14 MH that showed both a reduction of the MLD and an increase in the MHI after the primary repair closed after revisional surgery. Mean BCVA before revisional surgery was 0.86 logMAR (20/145 Snellen) but increased significantly post-operatively to 0.69 (± 0.15) logMAR (20/98 Snellen) at 3 months and to 0.49 logMAR (20/62 Snellen) at 12 month. CONCLUSION For persistent idiopathic MH simple repeat PPV with gas tamponade has a good anatomical and functional success rate in selected cases. MLD and MHI can be useful OCT markers for prognostic guidance.