The authors review all the modern literature on complications after phacoemulsification in high myopes with axial lengths (AL) greater than 25.0mm. Twenty-eight studies reporting on 19,586 eyes were included. The corrected distance visual acuity (CDVA) improved from 0.96 ± 0.53 logMAR to 0.35 ± 0.39 logMAR but the visual outcomes were worse than in the general population; 63% of eyes with AL longer than 26.0mm and 49% to 59% of eyes with AL longer than 30.0mm gained postoperative CDVA greater than 20/40. Posterior capsular rupture and retinal detachment were significantly higher at 3.91% and 1.74%, respectively, as compared to the general population. Myopic traction maculopathy was noted in 5.07% of cases. The rate of cystoid macular oedema at 0.5% fell within the rate in the general population of 0.1% to 2.35%. The cumulative rate of YAG capsulotomy, used as a marker for visually significant posterior capsular opacification, was 19.21% over a mean follow-up of 41.6 months which is comparable to the general population. Of interest, the pooled incidence of transient IOP elevation was raised at 28.15% from two studies with a total cohort of 120 patients. Highly myopic patients warrant closer attention and longer follow-up.