Objective To explore the influencing factors of intraocular lens (IOL) position after cataract surgery and analyze the effect of ocular biological parameters on IOL centering under different axial length (AL). Methods Patients who underwent cataract phacoemulsification and IOL implantation at West China Hospital of Sichuan University between February and July 2024 were prospectively selected. According to the different AL values, the patients were divided into non-high myopia group (22.0 mm≤AL＜26.0 mm) and high myopia group (AL≥26.0 mm) to explore the influencing factors of IOL position after cataract surgery. Results This study included a total of 240 patients (240 eyes), with 120 cases (120 eyes) in both the non-high myopia group and the high myopia group. The preoperative lens tilt and decentration of the non-high myopia group and high myopia group were (4.41±1.07)°, (0.13±0.09) mm and (3.57±1.81)°, (0.20±0.10) mm, respectively. The results of multiple linear regression analysis showed that in the non-high myopia group, preoperative lens tilt (P<0.001) was the influencing factor of postoperative IOL tilt, while lens thickness (P=0.027) and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. In the high myopia group, lens thickness (P=0.023) and preoperative lens tilt (P<0.001) were the influencing factors of postoperative IOL tilt, while anterior chamber depth (P=0.030), lens thickness (P=0.013), and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. Conclusion Ophthalmologists can accurately predict the postoperative IOL position based on the patient’s degree of myopia (with a focus on identifying high myopia) and specific ocular biological parameters before surgery, thereby optimizing surgical plans and improving postoperative outcomes.