Retinal atrophy and eccentric macular hole after internal limiting membrane peeling: a case report

This case highlights rare postoperative retinal atrophy and EMH formation following ILM peeling for MH repair. Potential contributors include ICG-induced photochemical toxicity, Müller cell damage from ILM peeling, and fluid shear stress. The findings underscore the need to optimize ICG protocols (reduced concentration, shorter exposure) and prioritize safer alternatives like brilliant blue G (BBG). Long-term postoperative monitoring is critical to detect delayed complications, emphasizing the balance between surgical efficacy and minimizing iatrogenic retinal injury.