Purpose To determine the long-term effect of internal limiting membrane (ILM) with associated epiretinal membrane (ERM) peeling versus single peeling alone in terms of best-correct visual acuity (BCVA) and anatomical outcomes on spectral-domain optical coherence tomography (SD-OCT). Methods This retrospective comparative cohort study of patients who had follow-up >1 year and underwent surgery for ERM by a single surgeon (SC) from January 1st, 2008-December 31st, 2012 compared cases in which the ILM was stained with brilliant blue G (BBG) to facilitate “double peeling” (n=42) to “single peeling” (n=43) of the ERM alone for up to 3 years of follow-up. For continuous variables, an independent 2-tailed t-test was performed. For binary variables, the Fisher exact test was performed. Statistical significance was defined as p<0.05. Results Eighty-five of 142 patients fit the inclusion criteria. At last follow-up, the single peeling group (SPG) were more likely to have ERM remaining in the central fovea postoperatively (p=0.0020, becoming significant by postoperative year 1, p=0.022) and less likely to develop inner retinal dimpling (IRD) (p=0.000, becoming significant by postoperative month 3, p=0.015). At 3 years, central foveal thickness had decreased in the SPG by −136.9-µm and by −84.1-µm in the double peeling group (DPG) respectively, which was not significantly different (p=0.08). Mean BCVA improved in both groups at all time points. There was no statistically significant difference between the two groups at 3 years (p=0.44, SPG=0.32±0.42, Snellen 20/42 (mean±standard deviation); DPG=0.23±0.27, Snellen 20/34). Conclusion BBG-assisted ILM peeling for ERM results in a more thorough removal of residual ERM around the paracentral fovea. However, there is no difference in long-term BCVA at 3 years and a greater likelihood of IRD.