AIM: To report the long-term outcome of posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic myopic foveoschisis (MF). METHODS: The records of 27 patients (44 eyes) treated with posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic MF were retrospectively reviewed. The best-corrected visual acuity (BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings and complications were analyzed. RESULTS: Forty-four eyes of 27 patients were included in this study. The follow-up period was 47.98 +/- 18.23mo (24-83mo). The mean preoperative BCVA (logMAR) was 1.13 +/- 0.63, and the mean postoperative BCVA was 0.30 +/- 0.33 at the last visit. There showed a significant improvement in BCVA postoperatively (P<0.001). Postoperative BCVA in 41 eyes (93%) was improved compared with the preoperative one. Forty-two eyes (95.45%) got total resolution of the MF after surgery. The remaining two eyes (4.55%) got partial resolution of foveoschisis. The preoperative foveal thickness was 610.45 +/- 217.11 mu m and the postoperative foveal thickness at the last visit was significantly reduced to 177.64 +/- 55.40 mu m (P<0.001). The preoperative axial length was 29.60 +/- 1.71 mm, and the postoperative axial length was 29.74 +/- 1.81 mm at the last visit. There was no significant increase in axial length within 47.98 +/- 18.23mo of follow-up (P=0.562). There was no recurrence of foveoschisis or occurrence of full-thickness macular hole during the whole follow-up period. CONCLUSION: For pathologic MF, PSR followed by vitrectomy is an effective procedure to improve the visual acuity and the anatomical structure of macula. It can also stabilize the axial length for a long time.