<![CDATA[Cataract surgery in patients with extreme axial myopia presents unique surgical challenges because of excessive axial elongation, difficulties in intraocular lens (IOL) power calculation, and potential zonular weakness. Implantation of an ultra-low power IOL is uncommon and may increase the risk of refractive prediction errors and capsular instability. Prophylactic use of a capsular tension ring (CTR) may improve capsular stability and postoperative IOL centration in selected high-risk eyes. A 49-year-old man with bilateral cataracts and extreme axial myopia presented with progressive visual impairment in both eyes. Preoperative best-corrected visual acuity was 1/300 in each eye, and optical biometry showed axial lengths exceeding 30 mm bilaterally. Sequential phacoemulsification was performed, with prophylactic implantation of a standard CTR followed by implantation of a +1.5-diopter posterior chamber IOL in each eye. The surgeries were completed without intraoperative complications. At one month postoperatively, best-corrected visual acuity improved to 20/50 in the right eye and 20/40 in the left eye. Both IOLs remained well centered, and no significant postoperative complications were observed. Conclusion was  Sequential phacoemulsification using an ultra-low-power IOL, combined with prophylactic CTR implantation, resulted in satisfactory early visual outcomes in this patient with extreme axial myopia. Careful preoperative planning, accurate IOL power calculation, and appropriate capsular stabilization are essential to optimize surgical outcomes in eyes with excessive axial length.]]>
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