This study retrospectively reviewed follow-up data (minimum one year) to evaluate ocular outcomes and the potential factors affecting visual acuity after foldable intraocular lens (IOL) implantation in preschool childhood (up to six years) with bilateral cataract. The study included 43 patients (86 eyes): 51 congenital and 35 developmental cataracts, during 2003-2018. There was a positive family history in four patients with congenital and two with developmental cataract. Median age at cataract extraction was 11.3 months (2.1 to 66) and at IOL implant, was 33.2 months (11-66). Fifty-two eyes had secondary IOL implant and 34 had primary IOL implant. Age at IOL surgery for congenital cataract was 28.86 ±9.98 months versus 40.92 ±15.4 months for developmental cataract. Median follow-up was 70.1 months (18.8-173.6) and median age at last follow-up was 7.7 years (3.9-15). All cases of strabismus and nystagmus were in the congenital group. Mean spherical equivalent was -1.31 ±3.84D and mean absolute spherical equivalent was 3.02 ±2.69D. In patients with glaucoma or history of high IOP, the spherical equivalent and axial lengths were higher than that of patients without these factors. In patients without glaucoma or raised IOP, the value of spherical equivalent was related to axial length and age at the last follow-up and were similar whether congenital or developmental cataract. BCVA at final follow-up was 0.42 ±0.32 logMAR: 0.20 ±0.19 for developmental cataract – better than 0.57 ±0.31 for congenital cataract. BCVA at follow-up was significantly associated with strabismus and nystagmus but not with age or presence of visual axis opacity. Better visual outcomes were noted in children with surgery at an early age with low refractive error. Postoperative complications occurred in 18 eyes. The findings highlight the importance of early detection and timely surgery for patients with congenital cataract. Visual outcomes in patients with developmental cataract were significantly better than those of congenital cataract which was not surprising. The authors recommend separating congenital and developmental cataracts when reporting treatment outcomes.