Outcomes of vitrectomy with or without internal limiting membrane peeling for the treatment of vitreomacular traction

OBJECTIVE: Vitreomacular traction is a common presentation that can benefit from surgical intervention. The decision to peel the internal limiting membrane (ILM) is made at the discretion of the operating surgeon. We describe a large cohort of eyes that had surgery with or without ILM peeling to give more evidence for the decision-making process. DESIGN: A retrospective cohort study. PARTICIPANTS: Eyes with the diagnosis of vitreomacular traction (VMT) that underwent surgery between January 1, 2016, and January 1, 2025, at a group retina practice in Edmonton, Canada. METHODS: Eyes at a single center underwent vitrectomy surgery for the treatment of VMT with or without peeling of the ILM. Baseline visual and anatomic measures were captured and compared to postoperative findings. The main outcome measures were visual acuity and anatomic outcomes postsurgery. Complication rates were also captured. RESULTS: A total of 250 surgeries were performed during the study period. There was a significant improvement in vision in all eyes (0.19 logMAR). There was no difference in visual improvement when comparing ILM peeling versus ILM sparing. There was better anatomical resolution in cases that had sparing of the ILM. Complication rates were low with no difference in secondary macular hole formation when comparing ILM peeling to ILM sparing. CONCLUSIONS: Pars plana vitrectomy with or without peeling of the ILM is an effective treatment for symptomatic VMT. There may be better anatomic preservation with sparing of the ILM secondary to less surgical manipulation. Complication rates are low regardless of surgical technique.