Purpose <p>To evaluate surgical outcomes and complications of a sutureless 27-gauge technique in congenital cataract surgery in comparison with a 23-gauge sutured method.</p> Methods <p>This retrospective, comparative study included 68 eyes of 41 patients (aged ≤ 12&#xa0;months at surgery) who underwent congenital cataract surgery. Group 1 included 25 eyes that underwent 27-gauge sutureless surgery, while group 2 included 43 eyes that underwent 23-gauge sutured surgery. Demographic, perioperative, and follow-up findings and measurements were recorded and compared. The main outcome measures were the number of general-anesthesia sessions, timing of postoperative visual rehabilitation, postoperative complications.</p> Results <p>Group 1 required fewer general anesthesia sessions than group 2 (3.60 ± 2.84 vs. 4.57 ± 1.52 sessions; <i>P</i> = 0.047) and initiated contact lens rehabilitation earlier (1.38 ± 1.03 vs. 3.93 ± 1.94&#xa0;weeks; <i>P</i> &lt; 0.001). Postoperative elevated IOP requiring medical therapy occurred in 10 (40.0%) cases in group 1 and 12 (27.9%) cases in group 2 (<i>P</i> = 0.304). One eye in group 2 also underwent trabeculectomy. Reoperation for iris tissue extending into the wound occurred for one eye in group 1 (<i>P</i> = 0.186), and anterior-chamber fibrin reaction occurred only in group 2 (4 eyes, <i>P</i> = 0.116). Visual axis opacifying membranes requiring vitrectomy developed in 4 eyes in each group (<i>P</i> = 0.408).</p> Conclusion <p>The 27-gauge sutureless technique demonstrated comparable outcomes to the 23-gauge sutured method in congenital cataract surgery, with added benefits of fewer anesthesia sessions and earlier visual rehabilitation. These results support its use as a feasible and minimally invasive alternative for selected cases of congenital cataract.</p>