Purposes: The present meta-analysis compared the postoperative visual performance of primary intraocular lens (IOL) implantation and primary aphakia in cataract infants. Methods: We performed a systematic literature search in PubMed, EMBASE and Science Direct. Postoperative visual acuity (VA) and complications were extracted and pooled. Results: Four randomized controlled trails (RCTs) and seven retrospective studies were included. The postoperative VA in primary IOL group was better than that in primary aphakia group [MD=-0.12, 95% CI: (-0.19, -0.05), p=0.91]. There was no significant difference in the incidence of glaucoma, retinal detachment and nystagmus between primary IOL group and primary aphakia group [OR=1.27, 95% CI: (0.79, 2.05), p=0.84 for glaucoma; OR=0.49, 95%CI: (0.07, 3.30), p=0.34 for retinal detachment;; OR=1.11, 95%CI: (0.62, 1.98), p=0.73 for nystagmus]. Analysis of unilateral subgroup indicated there were fewer infants with strabismus in primary IOL group compared with primary aphakia group [OR=0.40, 95% CI: (0.21, 0.79), p=0.46]. The primary IOL group needed more visual axis opacification (VAO) clearing than primary aphakia group [OR=9.33, 95%CI: (5.21, 16.73), p=0.27]. Conclusion: Primary IOL implantation provided more visual benefits. IOL implantation may decrease the incidence of strabismus in comparison with primary aphakia in unilateral subgroup. However, these advantages could be offset by a higher VAO clearing surgery.