To investigate closure rates and functional outcomes of surgery for refractory and recurrent macular holes (MH) in a real-world setting. Retrospective review of secondary MH surgeries. A total of 72 eyes from 72 patients were included. Eyes had a mean of 1.51 surgeries before inclusion into the study with a mean MH size of 762 µm and a mean baseline logMAR BCVA of 1.11(∼20/260 Snellen). Closure rates were 89.3 % for tissue transplantation, 77.3 % for ILM flaps, 92.9 % for MH manipulation, and 12.5 % for repeat ILM peeling (p<0.05). BCVA changes in logMAR from baseline to postoperative month 6 were +0.29 for ILM peeling alone (15 ETDRS letters worse), -0.39 for macular hole manipulation (20 ETDRS letters improved), -0.23 for tissue transplantation (13 ETDRS letters improved), and -0.2 for ILM flaps (10 ETDRS letters improved; p<0.05). Secondary MH closure is possible using various surgical techniques with acceptable anatomical closure rates. Repeat ILM peeling is associated with the lowest closure rates and poorest functional results. To distinguish between techniques would require a large sample size of about 750 eyes.