To report the effect and visual improvement of internal limiting membrane (ILM) peeling, and epiretinal membrane (ERM) peeling in symptomatic ERM with pseudolamellar macular hole.

This study included 27 eyes in 26 consecutive patients with ERM including pseudolamellar macular hole that underwent vitrectomy, ERM peeling, intravitreal gas tamponade, and maintained a face-down position for 7 days. ILM peeling was performed only in 13 eyes of 13 patients. The patients were divided into 2 groups: eyes with or without ILM peeling (14 eyes and 13 eyes, respectively) and the follow-up period was 12 months or more in all cases. The postoperative anatomic results based on optical coherence tomography (OCT) and improvement of best corrected visual acuity (BCVA) were retrospectively compared between the 2 groups.

Anatomic closure after surgery was achieved in 11 eyes (78.6%) in the ILM without peeling group and in 12 eyes (92.3%) in the ILM with peeling group ( p = 0.596). The BCVA improved from 0.41 ± 0.31 (log MAR) to 0.33 ± 0.21 in the ILM without peeling group ( p = 0.479) and from 0.46 ± 0.41 (log MAR) to 0.28 ± 0.25 in the ILM with peeling group ( p = 0.001).

ILM peeling with the addition of ERM peeling is an effective technique for BCVA improvement in the ERM with pseudolamellar macular hole. Vitrectomy, ERM peeling, gas tamponade, and ILM peeling are important for anatomic and functional success in the ERM with pseudolamellar macular hole.