Cataract surgery with intraocular lens (IOL) implantation in patients with small corneas and small lens is always a challenge.[123] Posterior chamber intraocular lens (PC IOL) is a well-accepted procedure for children as well as adults.Due to the sheer small size of the lens and the larger IOLs commonly available for implantation, they may contribute to complications such as glaucoma when such a normal-sized (relatively large) IOL is implanted. Glued IOLs have also been tried successfully in patients with microcornea with or without haptic trimming.[4] We conducted a study to implant reduced-size IOLs as secondary implants for children with aphakia.Authors[5] presented a case report where a custom-sized IOL was used and showed that it is safe. They implanted a reduced total size of 9 mm and an optic of 5 mm in the presence of a 9-mm-sized bag. The patient had a larger cornea and anterior megalophthalmos. This seems to be one of the first cases where the customized IOL was implanted in the bag.Similar problems could be encountered more frequently in small-sized cornea that is the microcornea patients. We shared our experience of 12 eyes with customized/small-sized IOLs in patients already operated for cataract and in the presence of microcornea. All surgeries were secondary IOL implantations. All patients had corneas smaller than 9.0 mm as their largest diameter. All IOLs were single piece PMMA IOL with variable optic sizes (4–5 mm) and variable total sizes (10–10.5 mm) depending upon the size of the cornea.A total of 12 eyes (n = 10) were implanted with the small-sized custom made IOL. The mean age was 11.7 ± 12 years. The mean horizontal corneal diameter was 8.83 ± 0.3 mm and the vertical diameter was 8.54 ± 0.4 mm. None of the patients developed glaucoma, although three patients developed optic capture. All IOLs were placed in the sulcus on the posterior capsular support. The vertical diameter of cornea of all the eyes was smaller or equal to the horizontal diameter of the cornea. All IOLs were, therefore, placed horizontally.Small corneas present a unique challenge for implantation of IOLs of normal size, especially if the corneal size is smaller than 9.0 mm. A normal-sized IOL may cause crowding in the angle and the resulting angle closure glaucoma when the IOL is implanted in the sulcus as secondary IOL. Agarwal et al.[4] described implanting a glued IOL where haptic externalization may circumvent this problem. Apart from the IOL sizing another issue is the IOL power which was more than 34 in 6 eyes in our series of 12 eyes.Both the sizing and power of IOL can be managed with custom made IOLs of small size. In our cases, we used both the readymade IOLs from aurolab, India and custom made IOLs from Care group, India.Sizing is an important issue. This case report gives wonderful insight regarding the usage and safety of reduced-sized IOLs.[5] We measured all corneas and added 1.0 mm to the total size of IOL on the horizontal diameter considering this as the size of the sulcus. None of our patients had decentered IOLs postsurgery. The optic size was selected based on the vertical diameter or the minimum diameter of the cornea. For corneas measuring 7.5–8.5 mm, we selected 4.0 mm optic size, for cornea diameter of 8.5–8.75 mm we selected 4.5 mm optic diameter, and for 9.00 mm corneal size we selected optic diameter of 5.0 mm.