The aim of the present study was to evaluate macular vascular density (MVD) variation after uneventful cataract surgery using optical coherence tomography angiography (OCTA) in patients with high myopia. Patients with cataracts scheduled for cataract surgery were divided into a high-myopia group [spherical equivalent (SE)≤-6.0 diopter (D) and axial length (AL)≥25 mm] and a low-myopia group (SE>-6.0 D and AL<25 mm). All patients were examined for MVD and retinal thickness (RT) with OCTA pre-operatively and post-operatively (1 day, 1 week, and 1 and 3 months after surgery). A total of 55 eyes from 44 patients were included. MVD and RT both changed after cataract surgery. The mean change in superficial vascular density (SVD) in patients with high myopia was significantly lower than that in the low-myopia group at the four post-operative time-points (all P<0.05). In addition, the RT of eyes with high myopia exhibited a different variation compared with that of the low-myopia group. Significant correlations were identified between AL, RT, intraocular pressure and SVD after surgery. In conclusion, superficial retinal perfusion in patients with high myopia was significantly lower than that in low myopia patients, which may lead to complications caused by poor perfusion.Copyright © 2020, Spandidos Publications.