Purpose: To evaluate the efficacy and safety of vitrectomy combined with inverted internal limiting membrane (ILM) flap technique and perfluoropropane tamponade (C3F8) for the treatment of high myopia macular holes (HMMH) with or without macular foveoschisis (MF). Methods: This is a retrospective, observational case series study. Sixty-seven eyes of 67 patients who underwent vitrectomy with inverted ILM flap and C3F8 tamponade were enrolled. The main outcome measures were best-corrected visual acuity (BCVA), the closure rate of HMMH and the integrity of ellipsoid zone (EZ) and external limiting membrane (ELM) at the final follow-up visit. Results：There was no significant difference in the BCVA and the closure rate of HMMH at the final follow-up between the two groups. However, the recovery of ELM and EZ was significantly higher in the no MF group than in the MF group at the final follow-up. Specifically, ELM and EZ were restored in 17 eyes (50.0%) and 10 eyes (29.4%) of the no MF group, respectively, while only 4 eyes (12.1%) and 2 eyes (6.1%) of the MF group achieved ELM and EZ restoration, respectively. Conclusion: Vitrectomy with inverted ILM flap technique and C3F8 tamponade is an effective and safe method to achieve a high anatomical success rate of HMMH closure and improve visual function. However, the presence of foveoschisis may impair the structural recovery of the outer retinal layer.