This was a prospective study comparing the outcomes, feasibility and safety of clear corneal cataract surgery with or without sutures in children with paediatric cataract. There were 85 eyes in each group (170 eyes of 110 patients). Each eye was randomised. After exclusions, there were 75 eyes in the suture group and 73 in the sutureless group. There were more males than females in both groups. Mean age was 5 ±2 years. Lamellar cataract was most common. Groups were comparable for demographics and preoperative characteristics. Induced astigmatism of 1.01D was noted in the suture group, and 0.74D in the sutureless group. Sutures resulted in postoperative discomfort in 9.3%. One patient developed endophthalmitis after suture removal and vision was lost in the eye. All children were aged two to eight years. The results indicate sutureless hydro closure approach was satisfactory and not inferior to the standard suture approach. The authors acknowledge it is not always appropriate, but when appropriate, sutureless is associated with reduced surgery duration, avoids suture-related complications and repeat GA to remove sutures. Overall, groups had similar complications, no hypotony and comparable IOP measurements postoperatively.