AIM: To find out intraoperative and postoperative outcomes of congenital cataract surgery in eyes with microcornea. METHODS: This retrospective consecutive case series study compared outcomes after congenital cataract surgery in eyes with/without microcornea. Infants (<1 year old) who underwent lensectomy surgery left aphakic were included. Microphthalmos was defined as an eye that has a horizontal corneal diameter less than or equal to 9.0 mm. RESULTS: There were 40 infants (54 eyes) in the microcornea group and 58 (87 eyes) in the control group. The two groups were age- and sex-matched. The microcornea group showed significantly smaller corneal diameter (P<0.001), steeper corneal keratometry (P=0.001), thinner lens thickness (P<0.001), and shorter axial length (AL, P<0.001). And microcornea increased the incidence of poor pupil dilation (P<0.01). The two groups showed no significant differences in postoperative intraocular pressure (IOP), best-corrected visual acuity, central corneal thickness (CCT), AL, and the incidence of strabismus and nystagmus at the last follow-up. CONCLUSION: Although microcornea have different features from normal ones, the one-year follow-up after surgery has shown that early surgical intervention for congenital cataracts in eyes with microcornea can result in favourable outcomes with an acceptable rate of postoperative complications. Regular follow-up and timely management of postoperative complications are crucial for successful outcomes.