Background: The aim of this study was to prospectively assess refractive results of cataract surgery in highly myopic eyes using the SRKT formula and Wang Koch-adjusted axial length. Material and methods: Prospectively, we recruited consecutive candidates for cataract surgery having an axial length equal to 27 mm and longer. We performed biometry by using Wang and Koch-adjusted axial length applied to the SRKT formula. The main outcome measures were: mean of refractive error, mean of absolute refractive error, and percentage of eyes that achieved a refractive error of ± 0.5D and ± 1D. Results: Fifteen eyes of nine patients were involved in the study. The mean refractive error was -0.01D ± 0.4D, and the mean absolute refractive error was + 0.35D ± 0.20D. Refractive errors of ± 0.5D and ± 1D were achieved, respectively, in 86.6% and in 100% of eyes. Conclusions: Wang Koch’s axial length adjustment applied to the SRKT formula is a reliable alternative in high myopic cataract patients.