In this video presented during the Retinaws symposium at the 2011 Annual Meeting, Dr. Kirk Packo shares pearls and pitfalls for internal limiting membrane (ILM) peeling. In two cases, Dr. Packo demonstrates how aggressive peeling with either ILM forceps or the Tano scraper can result in a paramacular hole. While such holes cause no visual symptoms and require no management, Dr. Packo advocates starting the ILM peel inferior to the macula to minimize adverse effects in case the surgeon instead induces a scotoma.