This is a retrospective audit of a five year study period, between the periods of January 2006 to December 2010, where a surgical log book search was performed. The inclusion criteria of this study were intraocular lenses (IOL) power greater than 30 D for anterior chamber fixated IOLs and greater than 35 D for posterior chamber-fixated IOLs. The other inclusion criteria for this study is a secondary intraocular lens implantation procedure and patients who had been left aphakic following primary operation to identify microphthalmic eyes that may not have received an intraocular lens implant at the same time as the cataract surgery. Exclusion criteria included an axial length greater than 20.9mm, previous intraocular surgery and other intraoperative surgical procedures apart from cataract surgery, and previous history of uveitis and surgeon in training. Forty-seven eyes fulfilled the criteria and were treated in two locations which include the Moorfields Eye Hospital and the Moorfields St Ann’s Cataract Centre. No serious intraoperative adverse events were recorded apart from the one case of iris prolapse with iris trauma, one case of endothelial corneal touch, one case of retinal detachment, two cases of postoperative inflammation and one case of chronic cystoid macular oedema. Postoperative corrective distance visual acuity was logMAR 0.3 or better in 24 eyes (62%) and only three eyes obtained worse vision. The overall ocular comorbidity rate was 53%. Ten microphthalmic eyes (26%) presented with associated congenital or hereditary pathology, and had worse visual outcomes (p<0.0001). Associated ocular diseases include: 51% study eyes include 10 eyes with congenital or hereditary pathology – one case of Leber congenital amaurosis, two cases of ocular cutaneous albinism, one case of retinal coloboma, one case of congenital cataract, three cases of retinitis pigmentosa and one case of corneal dystrophy. Acquired associated pathology include: six eyes with chronic angle closure glaucoma, two cases of pseudoexfoliation syndrome, one case of diabetic maculopathy and one case of Fuchs dystrophy. The authors conclude that microphthalmic eyes having high intraocular lens power are rare, and their presence is often associated with other ocular congenital or acquired conditions, as noted above. The authors conclude that the overall clinical outcomes were satisfactory and the surgical procedure affected by a low complication rate, as noted above.