Purpose: To evaluate visual outcomes and recurrence rates of macular pucker in patients undergoing membranectomy with and without internal limiting membrane (ILM) peeling. Methods: Retrospective study of consecutive series of patients undergoing membranectomy with and without ILM peeling. Results: Forty patients underwent vitrectomy and macular pucker surgery; 20 patients had concurrent ILM peeling and 20 patients had no ILM peeling. Follow-up ranged from 6-24 months (mean 16 months). Vision improved in 100% of eyes with ILM peeling and 70% of eyes without ILM peeling. Ten patients (50%) with ILM removal and six patients (30%) without ILM removal had best-corrected visual acuity (BCVA) of ≥20/25. At 16-month follow-up, 20% of eyes without ILM peeling and no eyes with ILM peeling showed recurrent macular pucker. Conclusion: Macular pucker surgery with ILM peeling results in better visual outcomes and fewer recurrences versus surgery without ILM peeling.