Modern approaches to ILM peeling in macular hole and epiretinal membrane surgery: benefits, risks, and surgical innovations

Aim
To provide a comprehensive overview of the role of internal limiting membrane (ILM) peeling in macular hole (MH) and epiretinal membrane (ERM) surgery, with a focus on its indications, surgical techniques, associated benefits, and potential complications.

Introduction
ILM peeling is widely used in the management of various retinal disorders, including MH and ERM. The procedure promotes retinal regeneration and functional recovery by eliminating tractional forces and minimizing the risk of postoperative ERM recurrence.

Material and methods
This narrative review presents various techniques for ILM removal, ranging from the traditional pinch-and-peel method to modern approaches using specialized peeling knives. Key surgical instruments and dyes used for ILM visualization are discussed in detail. The review also analyzes the indications for the procedure, potential benefits, and possible complications.

Results
ILM peeling is performed to enhance the anatomical and functional conditions of the retina, demonstrating high efficacy in the management of MH and ERM. The choice of ILM peeling method depends on the surgeon’s preference and the severity of retinal pathology. However, the procedure carries risks of complications. Furthermore, the use of dyes for ILM visualization poses a risk of retinal toxicity.