Purpose <p>To compare the efficacy of pars plana vitrectomy with or without air tamponade for patients with myopic foveoschisis (MFS) and foveal detachment (FD).</p> Methods <p>Forty-seven patients (47 eyes) with MFS and FD who underwent PPV with fovea-sparing internal limiting membrane peeling were included in this retrospective analysis. Patients were divided into air-tamponade (<i>n</i> = 21) and no-air-tamponade (<i>n</i> = 26) groups. Central foveal thickness (CFT), external limiting membrane (ELM) / ellipsoid zone (EZ) integrity, best-corrected visual acuity (BCVA), and incidence of complications were compared.</p> Results <p>In longitudinal analysis, the air-tamponade group had significantly faster CFT reduction at 1 week and 1 month (both <i>P</i> &lt; 0.05). By 3 and 12 months, the CFT values were comparable between groups. Time to foveal reattachment was shorter with air tamponade (<i>P</i> &lt; 0.001). The ELM and EZ integrity were compared at 12 months (both <i>P</i> &gt; 0.05). Postoperative BCVA showed significant improvement from baseline at 3 and 12 months in both groups (<i>P</i> &lt; 0.05). The time-by- tamponade type interaction at 3 and 12 months was not significantly different on BCVA in multivariable model (<i>P</i> &gt; 0.05). Baseline diameter of FD was identified as an independent risk factor of 12-month BCVA by multivariable analysis. Complication rates, including postoperative macular hole, macular hole with retinal detachment, and transient aggravation, did not significantly differ between groups.</p> Conclusion <p>Air tamponade accelerated early anatomical recovery in MFS with FD, but both tamponade types achieved comparable long-term anatomical and visual outcomes. Baseline FD diameter was the independent predictor of visual outcome.</p> Clinical trial number <p>Not applicable.</p>