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Microphthalmos is a congenital ocular abnormality that mainly manifests as a significant reduction in the size of the eye and is often associated with cataracts and other eye diseases. Due to its special anatomical features, cataract surgery in microphthalmos has a higher risk of intraoperative and postoperative complications and impaired visual prognosis and is associated with reduced intraocular lens (IOL) calculation accuracy. This chapter describes the characteristics of microphthalmic cataract surgery, the incidence of complications, classic and additional surgical procedures (e.g., phacoemulsification combined with prophylactic anterior lamellar sclerostomy, laser peripheral iridotomy, anterior segment vitrectomy, piggyback IOLs), and selection of IOL calculation formula.