AIM:To study the factors influencing the refraction of high myopia patients with cataract after phacoemulsification and intraocular lens implantation. METHODS:Phacoemulsification and intraocular lens implantation were performed on 30 patients (38 eyes) with axial high myopia and cataract. Three months after operation, postoperation refractions were measured and compared with predictive refractions. RESULTS: The average predictive refraction of 38 eyes was -1.39±0.47D.The average postoperative refraction was -0.87±0.93D.The average refraction error was -0.67±0.74D.There was significant statistical difference (t=3.375,P=0.002). There was low correlation between absolute refraction error and k-reading (r=0.443), and there was high positive correlation between refraction error and axial length (r=0.909). The absolute refraction error increased with the axial length growth. The average refraction error in eyes with axial length of 26-29mm was 0.61±0.39D, and with axial length ≥29mm was 1.37±0.84D.The difference was statistically significant (t=2.8601,P=0.005). The absolute refraction errors in eyes with axial length of 26-29mm were all less than 2.00D, and the refraction errors of six eyes with axial length of ≥ 29mm were ≥ 2.00D, accounting for 32%. CONCLUSION: The axial length is one of the most important factors which influence the postoperative refractive error of high myopia with cataract surgery.