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Fovea Sparing ILM Peeling for Vitreomacular Traction with Foveal Detachment

VMT with Foveal detachment can be associated with a very thin foveal roof; Surgery is indicated to prevent formation of a full thickness macular hole. As in any other macular surgery midperipheral vitrectomy should be done to separate posterior vitreous from peripheral vitreous before PVD induction to avoid transmitting traction during PVD induction to peripheral retina causing peripheral retinal tears. Vitrectomy and PVD induction should be done keeping in mind the need to minimise any traction over the thinned out foveal roof. For PVD induction, where possible, use higher cutting and low suction instead of high aspiration over the posterior pole to avoid foveal deroofing. ILM Peel is optimal but not mandatory in this situation. It may help prevent a future macular hole. ILM peeling however should be avoided across the fovea specially if the foveal roof is very thin as this could cause a macular hole. When there is doubt that a hole may have formed during the surgery, can complete the ILM peeling as any macular hole case and follow it up with FAE and gas fill with face down position for 3 days. That should take care of any inadvertent hole formation.