Myopic foveoschisis with foveal detachment had been treated by vitrectomy without ILM peeling as well as foveal sparing ILM peeling in an attempt to reduce the occurrence of postoperative complications. We performed this retrospective study to assess which is the best method for improving anatomical and functional outcomes, and to reduce the incidence of postoperative macular holes. Purpose To compare the visual and anatomical outcomes of two different treatment strategies (non-internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling) for retinoschisis with foveal detachment (FD) in highly myopic eyes. Design A retrospective cohort study. Methods Ninety-five eyes from 92 highly myopic patients with retinoschisis with FD were divided into two groups, including 44 eyes from 43 patients who received 23-gauge, 3-port vitrectomy without ILM peeling (group A) and 51 eyes from 49 patients who received vitrectomy with fovea-sparing ILM peeling (group B). All eyes also underwent cataract surgery. Results There were no significant differences between the two groups in terms of sex, age, diopters, axial length (AL), or central foveal thickness (CFT) before surgery (P > 0.05). One month after surgery, foveoschisis and FD were resolved in 74.47% of the eyes in group B and in only 12.50% of those in group A. Six months after surgery, foveoschisis and FD were resolved in 96.08% of the eyes in group B and in only 72.73% of those in group A (P < 0.05). There were no significant differences between the two groups in terms of BCVA 6 months after surgery. The postoperative complication was macular holes, which were found in seven eyes (15.90%) in group A and in one eye (1.96%) in group B (P < 0.05). Conclusion Highly myopic eyes with FD that underwent fovea-sparing ILM peeling appeared to obtain a better anatomical outcome than those that did not undergo non-ILM peeling. The two procedures obtained similar results in terms of visual function.