Background <p>To evaluate the macular anatomical reduction and visual outcome of vitrectomy with internal limiting membrane (ILM) peeling and flap insertion to that with flap inverted in the treatment of myopic macular hole in high myopia.</p> Method <p>This is a retrospective study. Main outcome measures were best-corrected visual acuity(BCVA) and morphology of macular hole. Collect baseline and postoperative data at 1, 3, and 6 months follow-up.</p> Result <p>The data collected in the study were obtained from 46 patients (46 eyes), among whom 25 patients had previously undergone vitrectomy combined with ILM insertion, while 21 patients had previously undergone vitrectomy combined with inverted ILM flap. The baseline BCVA of the ILM insertion and inverted ILM flap groups were 1.43 ± 0.68 logMAR and 1.60 ± 0.72 logMAR, which increased to 1.11 ± 0.30 logMAR and 0.98 ± 0.32 logMAR at 6 months post-surgery (<i>p</i> = 0.721). The incidence of anatomical closure of macular hole in the ILM insertion and inverted ILM flap groups were 88.46% and 95.24% at 6 months post-surgery (<i>p</i> = 0.824).</p> Conclusion <p>This study demonstrates that both vitrectomy combined with ILM insertion and the inverted ILM flap technique achieved favorable anatomical closure rates and visual improvement in the treatment of myopic macular hole without retinal detachment, with no serious complications observed. However, the comparative efficacy of the two techniques requires further validation through larger prospective studies.</p> Clinical trial registration number <p>ChiCTR2400094348. The registration date is December 20, 2024. Clinical Trial Registry: Chinese Clinical Trial Registry.</p>