Effects of internal limiting membrane peeling during macular hole surgery on retinal anatomical and functional outcomes

Idiopathic macular hole (IMH) refers to full thickness defects of retinal neuroepithelial layer in macular area without clear reasons, and the combination of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) is a standard procedure for macular hole.This technique can improve anatomical success and reduce the tangential forces, and thus accelerating the macular hole closure.With increasing use of ILMP and vital dye, the controversial issue of the intentional ILMP has arisen.First, the earliest change in the macula after ILMP is postoperative swelling of the arcuate retinal nerve fiber layer and dissociated optic nerve fiber layer occurs later in the postoperative period; second, retinal thickness modification, such as the thinning of retinal nerve fiber layer (RNFL), ganglial cell layer (GCL) and inner plexiform layer (IPL); third, displacement of foveal area toward optic disc and decrease of the foveal avascular zone area decrease retinal sensitivity and changes of the focal macular electroretinogram.This article reviewed the effects of ILMP during macular hole surgery on retinal anatomical and functional outcomes.