Expanding the indications of foveal sparing internal limiting membrane peeling

Background: Foveal-sparing internal limiting membrane (ILM) peeling is a vitreoretinal surgical technique designed to preserve the central foveal architecture while facilitating traction release in macular pathologies. It was initially described for myopic foveoschisis, [1] optic disc pit maculopathy, [2] and select cases of vitreomacular traction syndrome. [3] Purpose: To describe a series of cases where foveal-sparing ILM peeling was performed outside its traditional indications, highlighting surgical rationale, intraoperative nuances, and anatomical and functional outcomes. Synopsis: We present five cases, two of rhegmatogenous retinal detachment (RD), two cases of advanced proliferative diabetic retinopathy (PDR), one with chronic macular edema and the other with a foveal bleeder, and a final case of an epiretinal membrane (ERM) in a young patient with good baseline vision. In each case, a foveal-sparing ILM peel was employed, leaving a central island of ILM intact. This approach minimized traction on the foveal center, reduced the risk of iatrogenic macular hole formation, prevented foveal bleeders, and preserved postoperative foveal contour. All patients demonstrated anatomical restoration of the macula on optical coherence tomography, with improved best-corrected visual acuity at follow-up. Highlight: Foveal sparing ILM peeling traditionally preserved for select macular pathologies can be safely extended to a broader spectrum of vitreoretinal conditions. Through this video, we demonstrate its successful application in cases of rhegmatogenous RD, giant retinal tear RD, and PDR with chronic diabetic macular edema or foveal bleeders and even in young patients with an ERM. Video Link: https://youtu.be/MkEfcQ82biY