Purpose To evaluate the safety and efficacy of autologous Tenon capsule plug (ATCP) in surgical treatment of recurrent macular holes (MH). Methods In this study, 18 eyes of 18 patients who previously had surgery for MH and in whom the disease recurred more than two times underwent 23-gauge pars plana vitrectomy (23PPV). During surgery, an ATCP took in the same eye was applied at the macular area with the help of a live OCT scan integrated in the microscope. A complete eye visit with OCT scan was done before 23PPV and at 15 days and one and three months follow-up. Before surgery, mean best corrected visual acuity (BCVA) was 1.06 ± 0.24 logMAR; the mean of maximum MH diameters was 995.62 ± 361.04 µm, and the mean of minimum MH diameters was 765 ± 259.86 µm. Results At one month follow-up, an anatomical closure of MH was reached in 17 eyes. At three months follow-up, the closures were confirmed and the mean BCVA was 0.71 ± 0.29 logMAR, with significant improvement (P < .01) compared with preoperatively. No postop complications were observed at last follow-up. Conclusion According to the data observed, ATCP could represent a safe and interesting surgical approach in treatment of recurrent MH.