The primary management for epiretinal membrane (ERM) is membrane peel after pars plana vitrectomy. However, the rates of postoperative recurrence of epiretinal membrane reported range from 10 to 21%. Internal limiting membrane (ILM) peeling combined with ERM removal has been introduced in an attempt to diminish this recurrence. Some studies showed that this method largely prevented the recurrence compared with those without ILM peeling. Conversely, other studies demonstrated that combined ERM and ILM peeling did not provide a lower recurrence rate. Since the ILM is formed by the basal lamina of Muller cells, removal of this structure must be pondered due to possible mechanical and functional damage to those important cells. In this chapter, current data on this topic are covered.