Purpose <p>The purpose is to evaluate the effect of drainage from intentional extramacular holes after internal limiting membrane insertion to treat macular hole retinal detachment (MHRD) in highly myopic eyes.</p> Methods <p>This study is a retrospective, observational, and comparative case series that included 25 consecutive highly myopic eyes with MHRD. All eyes underwent standard 23-gauge vitrectomy, inverted internal limiting membrane insertion into the macular hole, subretinal fluid drainage from an intentionally created extramacular retinal hole, and tamponade with either silicone oil (SO group, n = 13) or perfluoropropane (C₃F₈ group, n = 12). A facedown position was maintained for 1&#xa0;week postoperatively. The anatomic and functional outcomes were compared between two groups at the endpoint.</p> Results <p>There was no significant difference in the retinal reattachment rate between the SO and C₃F₈ groups (100% and 91.67%, <i>P</i> = 0.48). The macular hole closure rates were 92.31% in the SO group and 100% in the C₃F₈ group (<i>P</i> = 0.52). The mean best-corrected visual acuity (BCVA) improved from 2.18 ± 0.60 logarithm of the minimum angle of resolution(logMAR) preoperatively to 1.11 ± 0.36 logMAR (<i>P</i> &lt; 0.01) in the SO group and from 2.20 ± 0.61 to 1.29 ± 0.50 (<i>P</i> &lt; 0.01) in the C₃F₈ group at the endpoint. There was no significant difference in BCVA improvement between the two groups (<i>P</i> = 0.37).</p> Conclusion <p>The drainage technique from intentional extramacular holes after internal limiting membrane insertion is an effective treatment for MHRD in highly myopic eyes, regardless of whether silicone oil or gas is used as a tamponade.</p>