Purpose: To evaluate macular changes after cataract surgery in eyes with HIGH MYOPIA. Methods: This prospective cohort enrolled patients with HIGH MYOPIA (axial length ≥ 26 mm) who underwent phacoemulsification with intraocular lens implantation. Spectral‑ domain optical coherence tomography (OCT) scans were obtained at baseline and 2 and 6 months after the operation. Postoperative macular changes on OCT scans were regarded as the main outcome measure. Results: Thirty‑ four eyes of 31 patients with HIGH MYOPIA were included (age, 60 ± 10 years [mean ± SD]); of these, 14 patients (45. 2%) were male. The mean axial length was 27. 8 ± 1. 5 mm. Epiretinal membrane (one eye, 2. 9%), lamellar hole (one eye, 2. 9%), myopic foveoschisis (2 eyes, 5. 9%), and vitreomacular traction associated with foveoschisis (one eye, 2. 9%) were notable findings at baseline examination; no eye showed cystoid macular edema (CME) at this time. At the 2‑ month examination, three eyes (8. 8%) developed CME. At the 6‑ month follow‑ up, one eye with CME at 2 months improved, and a new case of CME (5. 6%) was detected. The characteristics of epiretinal membrane, lamellar hole, vitreomacular traction, and foveoschisis did not change at the 2‑ and 6‑ month examinations and no new cases occurred. Conclusion: Uncomplicated phacoemulsification had no significant effect on the prevalence or characteristics of pre‑ existing macular abnormalities in eyes with HIGH MYOPIA up to 6 months of follow‑ up. The incidence of CME 2 months after uncomplicated cataract surgery in eyes with HIGH MYOPIA was about 9%.