Surgical management of pediatric cataracts, especially congenital cases, are complicated by the difficulty of adequate preoperative evaluation and their frequent association with additional ocular anomalies. Thus adequate preoperative planning is crucially important. The evolution of new technologies, especially intraoperative optical coherence tomography (OCT), allows the surgeon to better plan and customize surgical approaches. This video presents intraoperative OCT in a series of six unique and complex pediatric cataracts, as an aid to surgical planning and successful outcomes.