Removal of the internal limiting membrane (ILM) has been proposed as a useful surgical approach to enhance the closure of macular holes and the adjuvant indocyanine green (ICG) staining has been reported to facilitate ILM peeling. This study attempts to determine the efficacy and safety of ICG-assisted retinal ILM peeling in macular hole surgery. Seventeen eyes of 16 patients with stage 3 or 4 macular holes were included. All eyes underwent a pars plana vitrectomy, including the peeling of the posterior cortical hyaloid when necessary. ICG dye (0.5%) was instilled into the posterior vitreous cavity and left in place for 30 seconds. The retinal ILM was peeled after ICG removal. The procedure was completed with an intraocular tamponade (16% perfluoropropane), after which the patient remained in a face-down position for 1-2 weeks. ICG staining greatly facilitated the surgeon's ability to visualize and peel the ILM during surgery. Anatomic closure of the macular hole was achieved in 15 eyes (88.2%). However, the postoperative best-corrected visual acuity improved by two or more Snellen lines in only three eyes, remained the same in 13 eyes, and deteriorated in one eye. There was no statistically significant improvement in postoperative visual acuity. In conclusion, while ICG facilitates ILM peeling by providing a stark contrast between the stained ILM and the unstained retina, our results revealed that ICG might cause retinal damage and hinder visual acuity improvement.