Abstract: Objective To analyze the role of optical coherence tomography (OCT) in diagnosis of high myopia with macular retinoschisis and its prognostic assessment. Methods Clinical data about 42 patients (78 eyes) with high myopia admitted to our hospital from August 2009 to June 2011 with their visual acuity (VA) and refraction corrected were retrospectively analyzed. Their diagnosis was established by A/B ultrasonography and OCT scanning. The patients were divided into retinoschisis group and nonretinoschisis group. Their age, VA, diopter and ocular axial length were compared. The relation between retinal thickness and diopter was analyzed. Results OCT showed high myopia with macular retinoschisis in 25 eyes of 17 patients (32.1%). Of these eyes, 2 were diagnosed with macular retinoschisis accompanying macular membrane and 2 were diagnosed with macular retinoschisis accompanying vitrous traction. Of the 51 eyes of 26 patients with symptoms of metamorphopsia, shadow and reduced VA, 22 eyes of 14 patients were diagnosed with high myopia with macular retinoschisis. Of the 27 eyes of 16 patients with no such symptoms, 3 eyes of 3 patients were diagnosed with macular retinoschisis. No significant difference was found in the effect of age, VA, diopter and ocular axial length on macular retinoschisis (P> 0.05). Retinoschisis usually occurred in the fovea of 25 eyes involving 2-4 quadrants. Outer kinds of retinoschisis occurred in 15 eyes and mixed schisis in 10 eyes. Outer retinoschisis could exist independently and two or more types of retinoschisis could coexist in the same affected eye. No significant difference was found in the retinal thickness of retinoschisis and diopter (P> 0.05). The 25 eyes with macular retinoschisis were followed up for 12-20 months, during which macular membrane occurred in 2 eyes of 2 patients, retinal detachment in 1 patient due to vitrous traction and macular hole in 1 patient. Conclusion Regular OCT contribute to the early diagnosis and monitoring of high myopia with macular retinoschisis and can display it involved layers and morphology.