Related Experiment Video
Updated: Feb 20, 2026
Author Spotlight: Unraveling the Pathogenesis of Age-Related Macular Degeneration and Discovering Potential Therapies
Published on: July 28, 2023
TO PEEL OR NOT TO PEEL THE INTERNAL LIMITING MEMBRANE IN IDIOPATHIC EPIRETINAL MEMBRANES
Andrea Díaz-Valverde1, Lihteh Wu
1Macula, Vitreous and Retina Associated of Costa Rica, San José, Costa Rica.
Background:
Epiretinal membranes (ERMs) have been described for more than 150 years. Currently, they are a common indication for vitreoretinal surgery. Recently, there has been an increasing trend to peel the internal limiting membrane (ILM). Although ILM peeling has generally been accepted as a fundamental step in macular hole repair, its current role in ERM remains controversial.
Methods:
Literature review.
Results:
Proponents of ILM peeling argue that peeling of the ILM reduces the recurrence rate and facilitates a greater resolution of retinal folds. Opponents of ILM peeling show that the visual outcomes between eyes that undergo ILM peeling and those that do not have their ILM peeled are the same. Stripping of the ILM removes the Müller cell footplates, so it is reasonable to expect some Müller cell dysfunction. Adverse events such as eccentric paracentral macular holes, macular microscotomata, and retinal dimpling have been associated with ILM peeling.
Conclusion:
Internal limiting membrane peeling does not improve the functional outcomes after ERM surgery. Internal limiting membrane peeling reduces ERM recurrences, but many recurrences are not clinically significant. It remains unclear what the long-term effects of ILM peeling are. We should err on the side of caution and avoid routine ILM peeling in primary idiopathic ERM cases and should reserve it for recurrent and high risk of recurrence cases.
Insights
Internal limiting membrane (ILM) peeling in epiretinal membrane (ERM) surgery does not improve visual outcomes. While it may reduce recurrences, potential adverse effects suggest avoiding routine ILM peeling in primary ERM cases.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Vitreoretinal Diseases
Background:
- Epiretinal membranes (ERMs) are a common reason for vitreoretinal surgery.
- Internal limiting membrane (ILM) peeling is increasingly performed during ERM surgery.
- The role of ILM peeling in ERM surgery is currently debated.
Purpose of the Study:
- To evaluate the efficacy and safety of internal limiting membrane (ILM) peeling in epiretinal membrane (ERM) surgery.
- To analyze the impact of ILM peeling on functional outcomes and recurrence rates.
- To provide guidance on the routine use of ILM peeling in ERM surgery.
Main Methods:
- Comprehensive literature review of studies on epiretinal membrane (ERM) surgery and internal limiting membrane (ILM) peeling.
Main Results:
- ILM peeling does not enhance functional outcomes in ERM surgery.
- While ILM peeling can decrease ERM recurrence rates, many recurrences are not clinically significant.
- Adverse events associated with ILM peeling include macular holes, visual field defects, and retinal dimpling.
Conclusions:
- Routine ILM peeling is not recommended for primary idiopathic ERM cases due to lack of functional improvement and potential risks.
- ILM peeling should be reserved for cases with recurrent ERMs or a high risk of recurrence.
- Further research is needed to understand the long-term effects of ILM peeling.
