Purpose: To evaluate efficacy of vitrectomy with internal limiting membrane peel and silicone oil tamponade in highly myopic eyes with retinal detachment secondary to macular hole (MH). Methods: Twenty-one consecutive cases of MH-retinal detachment in highly myopic eyes were retrospectively reviewed. Eyes underwent pars plana vitrectomy, internal limiting membrane peeling, and silicone oil tamponade. A face-down or side-lying position was maintained postoperatively. Silicone oil was removed 3 months to 12 months later. Outcomes included MH closure and retinal reattachment rates, best-corrected visual acuity, and complication rates. Results: Mean patient age was 59.3 +/- 6.5 years and mean spherical equivalent was -15.2 +/- 4.3 diopters. After silicone oil removal, 18 eyes (86%) had MH closure with retinal reattachment and 2 eyes needed reattachment with endolaser photocoagulation and fluid/gas exchange, and 1 patient refused further treatment. At the last follow-up, median bestcorrected visual acuity was +1.48 +/- 0.12, up from preoperative +2.11 +/- 0.17 (P = 0.03). Transient intraocular pressure elevation was observed in 11 eyes (52%). Iatrogenic retinal break occurred in one case. Conclusion: Combining pars plana vitrectomy with internal limiting membrane peel and silicone oil tamponade was safe and effective in treating MH-retinal detachment in highly myopic eyes. Silicone oil tamponade may improve initial anatomical success rates because of longer tamponade duration.