Abstract

In macular hole surgery Internal membrane peeling is done to decrease the stretch of the internal limiting membrane (ILM) and seal the hole. The peel area is about one and a half disc diameter to avoid damage to the retina as the ILM is the condensation of the foot processes of the Muller cells and a large area of disruption could be deleterious to macular health. The massage makes the retinal tissue more pliable and flexible, and it slides toward the hole closing it. retinal massage is a good technique to get a Type 1 true hole closure rather than using the ILM flap as a scaffold, which usually leads to a Type 2 closure with poor visual recovery. But in a subset of cases, retinal atrophy is seen in some areas with RPE tracts and poor visual recovery because of the trauma induced to the ellipsoid zone by the procedure. This procedure is very helpful and simple and can be performed even by amateur surgeons in difficult macular hole surgeries.