Objective To investigate the changes of posterior chamber intraocular lens (ICL-V4c) implantation on retinal and choroid thickness, retinal blood flow density in the macular area, and optic disc in ultra-high myopia using optical coherence tomography angiography (OCTA). Methods From April 2020 to May 2021, 15 patients (30 eyes) with binocular equivalent spherical lens (SE) ≥–10.00 D in Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled. All eyes had undergone the ICL-V4c treatment. We observed the visual acuity and intraocular pressure at the following time points: before the operation, 2-hour, 1-week, 1-month, and 9-month post-operation. OCTA was used to monitor the changes in retinal and choroid thickness in the macular area as well as retinal blood flow density around the macular area and optic disc. Results There was no statistically significant difference between uncorrected viusal acuity postoperative and best corrected viusal acuity preoperative at each time point after surgery (P>0.05). The postoperative intraocular pressure showed a downward trend, but the difference was not statistically significant. The vault at 9-month post-surgery was significantly lower than that at 1-week post-surgery, the difference was statistically significant (P=0.002). There were no statistically significant differences in deep retinal blood flow density, retinal thickness or choroid thickness in the macular area, blood flow density in the radial capillary network around the optic disc, and nerve fiber layer thickness at each postoperative time point (P>0.05). The superficial retinal blood flow density in the four directions of upper, lower, nasal, and temporal decreased significantly 2-hour after surgery, with statistical significance (P<0.05). With the extension of time, the blood flow density in each area increased significantly, and there was no statistical difference compared with that before surgery (P>0.05). Conclusion OCTA observation showed that ICL-V4c implantation had an effect on the superficial retinal blood flow density in the early stage of ultra-high myopia but would restored to the preoperative level during the time, and had no effect on the retinal choroid thickness in the remnant macular area, the blood flow density of the capillary network around the optic disc and the thickness of the nerve fiber layer.