What does the “__block” keyword mean?

It tells the compiler that any variable marked by it must be treated in a special way when it is used inside a block. Normally, variables and their contents that are also used in blocks are copied, thus any modification done to these variables don't show outside the block. When they are marked with __block, the modifications done inside the block are also visible outside of it.

For an example and more info, see The __block Storage Type in Apple's Blocks Programming Topics.

The important example is this one:

extern NSInteger CounterGlobal;
static NSInteger CounterStatic;

{
    NSInteger localCounter = 42;
    __block char localCharacter;

    void (^aBlock)(void) = ^(void) {
        ++CounterGlobal;
        ++CounterStatic;
        CounterGlobal = localCounter; // localCounter fixed at block creation
        localCharacter = 'a'; // sets localCharacter in enclosing scope
    };

    ++localCounter; // unseen by the block
    localCharacter = 'b';

    aBlock(); // execute the block
    // localCharacter now 'a'
}

In this example, both localCounter and localCharacter are modified before the block is called. However, inside the block, only the modification to localCharacter would be visible, thanks to the __block keyword. Conversely, the block can modify localCharacter and this modification is visible outside of the block.