To analyze the visual results of phacoemulsification in highly myopic eyes, to investigate the risk factors for poor postoperative visual acuity and to assess postoperative complications.This retrospective study reviewed the records of 209 eyes of 150 patients with high myopia who underwent phacoemulsification and foldable intraocular lens (IOL) implantation between January 1998 and July 2008 at Beyoglu Education and Research Eye Hospital, Istanbul, Turkey.Postoperative best-corrected visual acuity (BCVA) was 0.5 or better in 63.2% of eyes. One hundred forty-seven (70.3%) eyes were within ±1.0 diopter (D) of the intended target refraction. In multiple regressions, only pre-existing myopic chorioretinal macular degeneration was found to be associated with poor BCVA (p=0.000). Nor patient age nor axial length (AL) had any correlation with postoperative BCVA. Retinal detachment (RD) occurred in one eye (0.5%) during mean follow-up (18.7+/-8.9 months).Most of the eyes with high myopia achieved satisfactory improvement in BCVA with few complications. Myopic retinal degenerative changes were the single independent factor limiting visual potential. Our lower incidence of postoperative RD could be attributed partially to our lower neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy rates and our surgical modification involving the implementation of primary posterior capsulorhexis in all patients younger than 40.