In this presentation from Pediatric Ophthalmology Subspecialty Day, Dr. Deborah Vanderveen discusses the special challenges of pediatric cataract surgery, particularly when the patient is very young and/or poorly cooperative. Preoperative assessment includes determination of whether the child is a good candidate for IOL implantation, and if so, a determination of the optimal IOL style and power must be made. The choice of IOL style usually depends on the anatomy of the eye and presence or absence of capsular support, with the first choice being within the capsular bag placement, followed by sulcus placement. Another choice that must be made is the power of IOL to be implanted because significant ocular growth and thus myopic shift will occur, even into the second decade of life. Since the greatest changes in axial length and refractive change will occur for children under 5 years of age, many surgeons will choose an IOL that leaves some residual postoperative hyperopia when operating for children in this young age group. IOL implantation in infants remains controversial, and the challenges inherent to IOL implantation in children are exaggerated for infantile eyes.