Purpose The purpose of this study is to evaluate the predictive factors for postoperative visual acuity improvement (PVAI) in subjects who underwent phakic intraocular lens implantation with a central hole (ICL-V4c) for ultrahigh myopia above - 10 D. Methods This was a retrospective study. Eyes with ultrahigh myopia above - 10 D undergoing ICL-V4c implantation were studied. Univariable linear regression models were used to assess the association between PVAI and preoperative parameters. Myopic maculopathy was classified into 5 categories by fundus photography. After the 1-month follow-up, the PVAI was compared within different age and preoperative spherical degree groups. Results This study included 726 eyes from 419 patients (111 men and 308 women), and the mean age, spherical refraction, and axial length were 28.67 +/- 7.93 years, - 13.61 +/- 3.44 D, and 28.59 +/- 1.50 mm, respectively. At baseline, myopic maculopathy was classified (grades C0-C4) as follows: C0 was observed in 200 eyes (27.5%), C1 in 297 eyes (40.9%), C2 in 147 eyes (20.2%), C3 in 22 eyes (3.0%), and C4 in 60 eyes (8.3%). The PVAI was significantly negatively associated with age and positively associated with SD-pre(-Sph), but no significant association between myopic maculopathy classification and axial length was found. After 1 month, 417 eyes (57.4%) gained more than 1 line at BCVA, 250 eyes (34.4%) remained the same, and 59 eyes (8.13%) lost 1 line. The postoperative visual acuity of 52 eyes was improved by more than 3 lines, and 42.3% were grade C4. Conclusions The ICL performed well for the correction of ultrahigh myopia above - 10 D. Younger patients and those with a higher preoperative spherical degree had greater postoperative satisfaction.