Lactic acid bacteria (LAB) fermentation has been proven to promote human health. The effect of different LAB fermentation on the quality of Opuntia ficus-indica fruit juice (OFIJ) was investigated. OFIJ was an excellent substrate for fermentation, with colony counts of more than 8 log CFU/mL after fermentation. The fermentation altered the acid and sugar contents. Simultaneously, the total phenolic and anthocyanin contents significantly increased. Antioxidant activity enhanced significantly in Lactiplantibacillus plantarum HNU082-fermented OFIJ, primarily in ABTS+ (increased by 16.81%) and DPPH (increased by 23.62%) free radical scavenging ability. Lacticaseibacillus paracasei HNU502-fermented OFIJ showed the most potent inhibition of xanthine oxidase (IC50 = 31.01 ± 3.88 mg TAC/L). Analysis of volatile and non-volatile compounds indicated that fermentation changed the flavor quality and metabolic profiles and caused the most significant modifications in amino acid metabolism. These findings offer valuable information into processing of OFIJ, making it a great choice for functional foods.