To report on a patient with bilateral macular holes who developed circular retinal pigment epithelial atrophy at the fovea after macular hole surgery using indocyanine green in both eyes. Interventional case report. A 68-year-old woman presented with a Stage 3 macular hole in each eye. Complete pars plana vitrectomy with indocyanine green-assisted internal membrane peeling was performed. The procedures were uneventful. The concentration and the exposure time to intravitreal indocyanine green were tolerable. One month after surgery, the macular hole was closed, but underlying circular retinal pigment epithelial atrophy was observed in both eyes. In clinical practice, if indocyanine green-related ocular toxicity develops in one eye after macular hole surgery, care should be taken regarding indocyanine green use during surgery of the other eye.