Advantages: 

An atraumatic ILM peeling is performed using the vacuum of the vitreous cutter, without a forceps, thus it is not traumatizing the retinal nerve fiber layer.

Methods:

This technique can be used both in 20 gauge and in 23 gauge, or 25 gauge surgery, in three different modes: either, the ERM is peeled using a traditional forceps; the ILM is usually partly removed, too; after another staining, the ILM is peeled using the vacuum of the cutter.  Alternatively, in cases without the ERM, the ILM is opened using a forceps or a scraper and the vacuum peeling can be performed. This technique restricts the number of instrument insertions into the eye. The third option is peeling of both membranes together. The procedure is illustrated using a video.

Effectiveness / Safety: 

The atraumatic ILM peeling brings diversification and innovation of the surgical options and it also brings some advantages over the traditional peeling with a forceps. However, this technique cannot be used in all macular procedures. An indelicate manipulation can cause retinal injury.