Aim To explore the factors affecting surgical outcomes of highly myopic macular holes (HMMHs).

Methods This is a retrospective cross-sectional study. Twenty-two eyes that underwent vitrectomy for HMMHs were included. The eyes were studied retrospectively and divided into two groups by preoperative optical coherence tomography (OCT): 10 eyes with retinoschisis around HMMH and 12 without. Preoperative status including age and posterior staphyloma height measured by OCT, and surgical outcome including postoperative final best-corrected visual acuity and reoperation rate, were evaluated and compared.

Results The schisis group was significantly older (p<0.01) with a worse visual acuity (p<0.05) and greater posterior staphyloma height (p<0.05). The preoperative best-corrected visual acuity and the presence or absence of retinoschisis were significantly (p<0.01 and p=0.01, respectively) associated with the postoperative best-corrected visual acuity; age was borderline (p=0.06).

Conclusion There are two types of macular holes (MHs) in highly myopic eyes with distinctly different prognoses. Preoperative OCT images must be interpreted carefully to determine the precise surgical results. Retinoschisis negatively impacts vitrectomy for HMMHs.