Purpose To review our experience with plasmin-assisted vitrectomy surgery for the treatment of pediatric macular holes. Design Retrospective, interventional case series. Methods Thirteen pediatric patients aged one to 15 years with a traumatic macular hole underwent surgical repair. All patients underwent surgery between February 1997 and March 2005 with autologous plasmin enzyme-assisted vitrectomy. After induction of posterior vitreous detachment (PVD), vitrectomy with membrane peeling and gas or silicone oil injection were performed followed by prone positioning for seven days. Main outcome measures included anatomic closure rate, visual outcome, and ocular complications. Results The macular hole was closed successfully in 12 (92%) of 13 cases. Of the 12 patients for whom vision could be measured, 11 patients (92%) had visual acuity improvement of 2 or more lines and six patients (50%) achieved vision of 20/50 or better; all of the patients achieved vision better than 20/200. The visual improvement was statistically significant (P = .005, Wilcoxon signed-rank test). Surgical complications included cataract formation in one patient and retinal detachment in one patient. Conclusions Autologous plasmin enzyme may be a helpful adjunct when performing vitrectomy for traumatic macular holes.