We report a case of rapid regrowth of an epiretinal membrane (ERM) after macular hole (MH) surgery using the inverted internal limiting membrane (ILM) flap technique. A 63-year-old woman presented with a large full-thickness macular hole (FTMH) with ERM in the right eye. We performed 27-gauge pars plana vitrectomy (PPV), and covered the fovea by inverting the upper ILM ?ap. After vitrectomy, the FTMH was closed. However, 1 month later, optical coherence tomography (OCT), showed ERM regrowth over a large area. We performed 27-gauge PPV with thorough ERM and ILM peeling. As of the 6-month follow-up, there has been no recurrence of ERM. There is a risk of rapid ERM developing after MH surgery using the inverted ILM flap technique, especially when residual ERM persists on the inverted ILM flap itself. Vitrectomy enables additional ILM peeling to aid ERM removal and improves visual and anatomic outcomes. Thus, it is imperative to ensure complete ERM removal from the ILM before flap placement and consider which part of the ILM should be used. We think that postoperative inflammation may also contribute to rapid ERM formation, so strong anti-inflammatory therapy after surgery is needed.