AIM: To evaluate the efficacy and safety of combining posterior scleral contraction (PSC) with intravitreal perfluoropropane (C3F8) injection in high myopia with macular hole retinal detachment (MHRD). METHODS: A total of 22 participants (22 eyes) with high myopia [axial length (AL)≥26.5 mm] and MHRD who underwent PSC combined with intravitreal C3F8 injection, with at least 6mo of follow-up were retrospectively recruited. Outcome measures included best-corrected visual acuity (BCVA), AL, optical coherence tomography (OCT) findings, and adverse events. Retinal recovery was categorized as type I (macular hole bridging with retinal reattachment) or type II (reattachment without hole bridging). RESULTS: The mean age of participants was 62.1±8.8y and mean follow-up duration was 9.18±4.21mo. Complete retinal reattachment was observed in 11 eyes (50%) at postoperative day 1, 19 eyes (86.3%) at week 1, and all 22 eyes at month 1. Ten eyes (45.5%) achieved type I recovery and 12 eyes (54.5%) achieved type II. Mean BCVA improved from 1.68±0.84 logMAR before surgery to 1.21±0.65 logMAR after surgery (P<0.001), and AL was significantly reduced compared to baseline (29.07±2.05 vs 30.8±2.2 mm; P<0.001). No serious complications were reported. CONCLUSION: PSC combined with intravitreal C3F8 injection is a safe and effective treatment for MHRD in highly myopic eyes, especially for retinal detachment limited within the vascular arcade.