Objective To evaluate the clinical effectiveness of idiopathic macular epiretinal membrane surgery with or without internal limiting membrane peeling. Methods Meta-analysis study. Searches were conducted in Pubmed, EMbase, Cochrane Library, CNKI, etc. Studies that met the inclusion criteria were selected for further analysis. The Downs & Black score was used for quality and comparability assessment, and the meta-analysis was performed using Revman 5.0 software. Results Eight studies in the literature were selected for meta-analysis, including a total of 417 eyes: one group had undergone epiretinal membrane (ERM) removal with internal limiting membrane (ILM) peeling (200 eyes) and the other group had undergone ERM removal alone (217 eyes). The results of the meta-analysis showed the following: ①Best corrected visual acuity (BCVA): The group that underwent ERM removal alone had better BCVA at the postsurgical follow-up after 3 months compared with the group that underwent ERM removal with ILM peeling [WMD=0.16, 95%CI(0.02, 0.29), P<0.05]. There were no significant differences in BCVA between the two groups at the postsurgical follow-up after at least 6 months [WMD=-0.06, 95%CI(-0.15, 0.03), P>0.05] and BCVA at the postsurgical follow-up after at least one year [WMD=0.04, 95%CI(-0.02, 0.09), P>0.05]. There were also no significant differences between the two groups in the incidence of people who did not have decreased vision at the postsurgical follow-up after at least 6 months [WMD=1.37, 95%CI(0.40, 4.76), P>0.05]. ②Central macular thickness: The central macula was thicker in the group that underwent ERM removal with ILM peeling when compared with the group that underwent ERM removal alone at the postsurgical follow-up after at least 6 months [WMD=26.43, 95%CI(8.12, 44.75), P<0.05]. There were no significant differences in central macular thickness between the two groups at the postsurgical follow-up after 3 months [WMD=20.42, 95%CI(-1.50, 42.35), P>0.05] and after at least one year [WMD=12.37, 95%CI(-11.29, 36.04), P>0.05]. ③The recurrence rate of the macular ERM: The group that underwent ERM removal alone showed a higher recurrence rate than the group that underwent ERM removal with ILM peeling [WMD=0.20, 95%CI(0.07, 0.61), P<0.05]. Conclusion  Compared with the group that underwent ERM removal alone, the group that underwent ERM removal with ILM peeling has no advantages in the improvement of BCVA and the reduction in central macular thickness, but ILM peeling significantly reduces the recurrence rate of idiopathic macular epiretinal membrane.