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PURPOSE To evaluate the impact of different intraocular tamponades on the visual-related quality of life (VRQOL) after idiopathic epiretinal membrane (IEM) surgery with epiretinal membrane peeling. METHODS We prospectively enrolled 50 patients diagnosed with IEM who underwent pars plana vitrectomy (PPV). Patients were consecutively assigned to either the air tamponade (air) group (25 patients) or the balanced salt solutions (BSS) tamponade group (25 patients). The following data were collected before and after surgery and compared between two groups: VRQOL, best corrected visual acuity (BCVA), intraocular pressure (IOP), metamorphopsia, contrast sensitivity (CS), and central macular thickness (CMT). RESULTS PPV was performed in 50 eyes. At baseline, there were no significant differences between the two groups. At 6 months postoperatively, VRQOL (p < 0.001), BCVA (p < 0.001), CMT (p < 0.001), CS (p < 0.001), and metamorphopsia (p < 0.001) improved significantly in comparison to baseline, without significant differences between the air tamponade and BSS groups. CONCLUSION Removing IEM significantly improved visual function and VRQOL. Despite improvements, our study showed no difference postoperatively whether air or BSS tamponade was used during surgery. As a result, air tamponade may not be a mandatory treatment for IEM surgery and provides no additional advantage compare with BSS tamponade.