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Background Refractive status is crucial to visual function and can change throughout life. For patients with congenital cataract, the developmental profi le of refraction is complicated owing to the potential infl uence of diverse clinical manifestations and various treatments, and has not yet been fully characterised.Methods In this prospective cohort study, we enrolled patients with congenital cataract from the Childhood Cataract Program of the Chinese Ministry of Health (CCPMOH). Two experienced cataract surgeons (YL and WC) did cataract removal or intraocular lens (IOL) implantation at Zhongshan Ophthalmic Center. Patients were followed up at 1 week, 1 month, and 3 months postoperatively, then every 3 months thereafter. Follow-up refraction assessments were conducted with objective retinoscopy and cycloplegia, and were performed by experienced independent optometrists. We compared refraction status (presented as spherical equivalent), and the rate of myopic shift between bilateral and unilateral congenital cataract with linear mixed model (LMM) analysis, then compared the range of myopic shift between bilateral and unilateral congenital cataract with multivariate linear regression Ethical approval was provided by the institutional review board of the Zhongshan Ophthalmic Center (Guangzhou, China). Parents of participating children provided written informed consent.