Myopic traction maculopathy is a high myopia-related complication caused by several mechanisms with traction as a common pathway. Macular hole-related retinal detachment is considered to be the final stage of progressive foveoschisis. In this setting, release of all vitreous and epiretinal tractions is essential in order to achieve surgical success. Pars plana vitrectomy has proven useful in the treatment of myopic foveoschisis, with both good visual and anatomical results. However, the surgical technique for the treatment of macular hole-related retinal detachment is still a controversial issue: reoperations are common and the final visual prognosis is limited, especially in those cases with a pronounced posterior staphyloma. We must also bear in mind that a highly myopic eye has some characteristic traits that may complicate vitreoretinal surgery. In these cases, microincision vitrectomy surgery may offer some advantages compared to conventional vitrectomy.