Congenital cataract is a relatively common childhood eye disease that can cause blindness, as the clouding of the lens that can affect vision is already present at birth or worsens with age. According to statistics, the prevalence of congenital cataract in China is about 0.05%, and it is often seen by parents who find that the child has white pupil area, does not follow things, sees things crookedly or has nystagmus. For the treatment of predilection, early cataract extraction can help children’s visual development, while for children with monocular predilection, it is important to correct the postoperative refractive aberration. A recent multicenter, randomized clinical study reviewed 114 cases of infants and children with monocular predilection treated surgically and compared the postoperative complications and secondary surgeries of both IOL implantation and corneal contact lenses. The study was conducted on children who underwent predilection surgery between 1 and 7 months after birth and was followed until the child reached 5 years of age. The investigators found that in the first year after surgery, postoperative complications and adverse events such as posterior cataract, pupillary zone membrane formation, pupillary ectasia, and secondary glaucoma occurred in 77% (44/57) of the IOL implant group and 26% (15/57) of the contact lens group, and at 1-year follow-up, due to an increase in contact lens-related adverse events such as corneal abrasions, corneal ulcers, and keratitis The incidence of adverse events was higher in the contact lens group than in the IOL group (contact lens group: 24/57, 42%; IOL group: 14/57, 25%), but overall, the incidence of postoperative adverse events was still higher in the IOL group than in the contact lens group (IOL group: 46/57, 81%; contact lens group: 32/57, 56%), and was most common in the first postoperative year. Also, at postoperative follow-up, a higher percentage of children with IOL implantation underwent reoperation – e.g., posterior obscuration, glaucoma surgery – (IOL group: 41/57, 72%; contact lens group: 9/57,16%;). However, in terms of postoperative visual prognosis, the visual acuity data of the two groups of children did not show significant differences at the age of 1 and 4.5 years. However, if we take into account the relatively high cost of corneal contact lenses, the poor compliance of the children, and the need to choose the right time for IOL implantation, which side of the scale will the clinician’s mind be tilted? In this case, it is not easy to make a comprehensive, holistic, and beneficial treatment decision.