AIM: To investigate the effect of posterior scleral reinforcement (PSR) on circulation of pathologic myopia eyes with posterior staphyloma by optical coherence tomography angiography (OCTA). METHODS: The study included 30 pathologic myopia eyes with posterior staphyloma which underwent PSR (PSR group) for 6 to 18mo ago, and 30 age and myopia matched eyes without PSR surgery as control group. Macular, choriocapillaris and radial peripapillary capillary (RPC) flow density were measured by OCTA, and the measurements were compared between groups. RESULTS: OCTA found no significant differences in macular flow density between PSR and control groups. For the superficial flow, whole enface flow density (WED), fovea density (FD), and parafoveal density (PD) were 46.55%±5.19% vs 47.29%±4.12% (P=0.542), 31.45%±6.35% vs 31.17%±4.48% (P=0.841), and 48.82%±5.66% vs 49.21%±4.15% (P=0.756) in PSR and control groups, respectively. For the deep flow, WED, FD, and PD were 52.07%±5.78% vs 53.95%±4.62% (P=0.168), 29.62%±6.55% vs 29.50%±6.38% (P=0.940), and 56.93%±6.17% vs 58.15%±5.13% (P=0.407) in PSR and control groups, respectively. The choriocapillary flow density was 61.18±3.25% in PSR group vs 60.88%±2.56% in control group (P=0.692). Also, OCTA found no significant differences in RPCs flow density between PSR and control groups. The optic disc WED, inside disc flow density and peripapillary flow density were 48.47%±4.77% vs 48.11%±4.57% (P=0.813), 45.47%±11.44% vs 46.68%±9.02% (P=0.709), 54.32%±5.29% vs 52.47%±6.62% (P=0.349) in PSR and control groups, respectively. CONCLUSION: OCTA provides a non-invasive and quantitative approach for monitoring macular and papillary blood flow in pathologic myopia. PSR can not improve but may maintain the circulation of pathologic myopia eyes with posterior staphyloma.