Objective To evaluate the effects of vitrectomy with internal limiting membrane (ILM) peeling on epiretinal membrane and visual acuity of rhegmatogenous retinal detachment (RRD) with severe proliferative vitreoretinopathy (PVR).Methods Sixty-two patients with RRD and PVR (C3 - D2) were enrolled in this study.The patients were divided into two groups:30 patients in group A had undergone conventional vitrectomy; 32 patients in group B had undergone vitrectomy and ILM peeling.All patients had been tamponaded by silicone oil after the operation.The logarithm of minimal angle of resolution (logMAR) visual acuity in group A and B before the operation were 1.47 ± 0.38 and 1.44 ± 0.33 respectively,the difference between two groups was not statistically significant (F=0.089,P=0.766).The follow-up period was 9 - 12 months.The silicone oil was removed three months after the operation.LogMAR visual acuity,ocular fundus,and optical coherence tomography had been followed up.Results Epimacular membrane formation was found in seven eyes (23.3％) in group A,but none in group B,the difference was significant (x2 =8.42,P=0.004).The logMAR visual acuity increased significantly both in group A (0.70±0.22) and B (0.57±0.17) at the last visit (t=16.881,17.887; P=0.000).The IogMAR visual acuity in group B was better than that in group A (t=2.497,P=0.015),the difference of vision improvement was not significant between those two groups (F=2.084,P=0.153).Conclusion Vitrectomy with ILM peeling can significantly inhibit the epimacular membrane formation and improve the visual acuity in eyes with RRD and severe PVR.