Background Macular hole (MH) with associated foveoschisis is very specific to highly myopic eyes with a pronounced posterior staphyloma. A high axial length increases the risk of foveoschisis, MH formation and retinal detachment secondary to a macular hole (MHRD). These highly myopic MH show poor surgical outcomes after vitrectomy and internal limiting membrane peeling compared with non-myopic MH. The posterior staphyloma seems to play an important role, and thus macular buckling could prove useful to improve both visual and anatomical results.

Methods Sixteen highly myopic eyes with MH and associated foveoschisis that underwent macular buckling were studied. Vitrectomy combined with macular buckling was performed in all 16 eyes. Optical coherence tomography was performed to confirm MH closure in all cases.

Results Combined vitrectomy and macular buckling resulted in MH closure in all patients. Best-corrected visual acuity (BCVA) improved in 13 out of 16 eyes (81.25%), remained stable in 2 eyes (12.5%) and worsened in 1 eye (6.25%). Mean preoperative BCVA was 20/125, whereas mean postoperative BCVA was 20/50.

Conclusions Combined vitrectomy and macular buckling is a safe and effective approach to achieve primary closure of MH in eyes with posterior staphyloma and associated foveoschisis. Eyes with a high axial length show a less favourable prognosis, which can be partially overcome by means of macular buckling.