The authors set out to evaluate an OCT-based positioning regimen for macular hole surgery. Patients were advised to maintain prone positioning until the hole was confirmed to be closed based on daily OCTs. Surgery consisted of 23-gauge phacovitrectomy with internal limiting membrane (ILM) peel and 20% SF6. A retrospective case note review was carried out on 33 patients (35 eyes) who had undergone this regimen. Mean baseline visual acuity was 20/220 with a mean hole size of 465 microns. Seventeen percent were diagnosed with myopic degeneration, while 37% were found to have chronic holes (more than or equal to 12 months duration). Day one OCT images were obtained in 89%, day two in 97% and day three in 100% of eyes. The authors suggest to obtain clear OCT images in gas filled eyes, the focus on the OCT machine should be set between -10D and -20D. Closed holes began to reopen by the first postoperative week. Eighty-nine percent were closed on day seven, 83% closed on day eight to 14, 80% were closed one month after surgery. Three percent did not close postoperatively, 9% reopened at two weeks, 3% reopened at four weeks and 3% at six weeks. Risk factors for failure to maintain closure were identified as large holes, chronic holes and myopic degeneration. The authors suggest if the patient has no risk factors, positioning can be stopped once the hole has closed. If the patient has one risk factor, advice to position can be extended for a few days after hole closure. If the patient has two or three risk factors, seven days of prone positioning even if the hole is closed on day one is recommended using this OCT based positioning regimen.