Until very recently the ILM was considered to be an integral part of the retina, and vitreoretinal surgeons did not think that it could be removed without causing visual damage. However, the publication of a number of primary reports of cases of spontaneous separation of the ILM, which resulted in no significant fibrosis and good visual acuity after surgery, has driven a change in the opinion of vitreoretinal surgeons on the possibility of removing the ILM to release vitreoretinal tractions [
15,
16]. This change is also driven by additional findings. Histological studies on the removed ERM showed that, in up to 60% of patients, the ILM and ERM were removed together at the same time [
17,
18]. It has also been reported that ILM specimens that were removed after ERM peeling demonstrated the presence of microscopic ERM remnants that persisted over the ILM in almost one-half of the patients; these ERM remnants could ultimately form islands of re-proliferation [
4,
18,
19,
20]. Thus, ILM removal provides the certainty of having removed all cells that produce collagen above the retina. Additionally, this procedure ensures that all adhesions distorting the inner retina have been released. Therefore, the simultaneous removal of ERM and ILM has become a widely approved procedure in vitreoretinal surgery. Since the early 1990s, numerous studies have confirmed that ILM removal is associated with better anatomical improvement, better final vision outcome and lower risk of recurrence [
3‐
6]. In one study, ILM peeling was also found to be the superior surgical approach to resolving cystoid macular edema due to less epiretinal traction, which disappeared in 90% of the patients, compared to 44% of patients who underwent removal of the ERM alone [
3]. However, many other comparison studies found no functional difference between both groups [
13,
14]. In addition, one retrospective study found ILM removal was correlated with worse visual outcome [
21]. Tadayoni et al. first reported anatomical damage after ILM peeling and described a peculiar macular appearance, called “dissociated optic nerve fibre layer” (DONFL), which appears 1–3 months after surgery and leads to a thinning of the inner retina, causing a reduction in visual outcome [
11]. Spaide et al. later clarified that DONFL corresponds to inner retinal dimples that course along the path of the nerve fiber layer. The dimples seem to be the result of an interplay between trauma and healing processes constrained by nerve fiber layer and do not appear to be due to any dissociation of optic nerve fibers. Furthermore, thickening of the macula without foveal depression has been found in 84% of eyes of ILM-peeled eyes, compared to 43% of eyes with unpeeled ILMs [
10]. The authors of that study hypothesized that ILM peeling could damage the Müller cell footplates which form the inverted cone scaffold that gives the navel shape to the fovea.