Background <p>To examine the clinical features and long-term surgical results of highly myopic full-thickness macular hole (FTMH) without retinoschisis.</p> Methods <p>We retrospectively assessed surgical outcomes of highly myopic patients who underwent vitrectomy with internal limiting membrane peeling and gas tamponade to treat FTMH without retinoschisis. Post-operative examinations were conducted at 1, 3, 6, and 12 months after surgery, with further follow-up intervals adjusted based on physician’s discretion. Clinical features related to visual acuity and anatomical success, defined as hole closure without developing foveal atrophy, were assessed.</p> Results <p>Thirty-three eyes (30 patients) were included, and the mean follow-up period was 61.1 ± 48.8 months. Macular hole closure was achieved in 31 (93.9%) eyes, of which 16 (51.6%) developed foveal atrophy during follow-up. Eyes with anatomical success exhibited a significant better visual prognosis than those without during whole follow-up period (<i>P</i> ≤ 0.031), showing a significant postoperative visual improvement from baseline at 6 months, 12 months and final visit (<i>P</i> = 0.002, <i>P</i> &lt; 0.001 and <i>P</i> = 0.013, respectively). Greater minimal macular hole diameter (<i>P</i> = 0.002) and the presence of posterior staphyloma (<i>P</i> = 0.040) were significantly related to anatomical failure, whereas longer axial length was significantly related to poorer final best-corrected visual acuity (<i>P</i> &lt; 0.001).</p> Conclusions <p>Hole closure rate after vitrectomy in highly myopic patients with FTMH without retinoschisis was high. However, the postoperative development of foveal atrophy hindered vision improvement. Posterior staphyloma, greater minimal hole diameter, and longer axial length were predictive of poor prognosis.</p>