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AimTo observe the postoperative efficacy and factors affecting refractive status following combined vitrectomy and cataract surgery for high myopia (HM) with cataract and vitreous opacities, and compare the differences in refractive status between eyes with and without posterior capsulotomy.MethodRetrospective case study, a total of 57 patients (81 eyes) diagnosed with HM complicated with cataracts and vitreous opacity at Shanghai Aier Eye Hospital between 01/01/2022 and 01/01/2025.were included in the study, who underwent pars plana vitrectomy (PPV) combined with cataract phacoemulsification and intraocular lens (IOL) implantation. Preoperative examinations included best corrected visual acuity (BCVA), IOL-master, and Pentacam, with IOL power calculated using the Barrett formula. Postoperative follow-up was conducted at 3 months, including BCVA and refraction assessment. Besides, compared and analyzed the refractive status of eyeballs with and without posterior capsule incision during surgery(60 eyes with posterior capsulotomy and 21 eyes with posterior capsule preservation).ResultsThe mean axial length (AL) of patients’ eyes was 29.77 ± 2.55 mm, and the mean preoperative BCVA was 0.64 ± 0.60 (LogMAR). Three months postoperatively, the mean BCVA improved to 0.40 ± 0.43 (LogMAR), showing a statistically significant improvement (P ConclusionCombined surgery for HM with cataract and vitreous opacities improves postoperative vision. The mean deviation between reserved refraction and target refraction is less than 0.5 D. Refractive deviation is significantly correlated with preoperative/postoperative SE and reserved degree, may have a positive correlation with age,and may be negatively correlated with ACD. Posterior cystectomy may also be one of the influencing factors in reducing refractive deviation.