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AIM: To compare the clinical outcome of anterior chamber intraocular lens(IOL)at Ⅰ stage versus sclera-fixed IOL at Ⅱ stage in complicated cataract surgeries with inadequate capsular support. <p>METHODS: Complicated cataract surgeries with anterior chamber IOL(ACIOL)or scleral-fixated IOL implantation from January 2003 to December 2014 when capsular support was inadequate were included and analyzed. Postoperative best-corrected visual acuity(BCVA)were compared. Postoperative complications were recorded and analyzed. <p>RESULTS: Totally 84 eyes and 79 eyes were included in the ACIOL group and in the scleral-fixated IOL group, respectively. The mean postoperative logarithm of minimal angle of resolution(LogMAR)BCVA at 1a was 0.30±0.64 and 0.33±0.34 in the ACIOL group and the scleral-fixated IOL group, respectively(<i>t</i>=0.407, <i>P</i>=0.712). The mean latest LogMAR BCVA was 0.67±0.55 and 0.62±0.50 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively(<i>t</i>=0.225, <i>P</i>=0.545). There were more early postoperative complications in the ACIOL group(<i>χ²</i>=14.613, <i>P</i><0.001). No difference in late postoperative complications was found between the two groups(<i>χ²</i>=0.231, <i>P</i>=0.267). Regression analysis suggested that ACIOL and scleral-fixated IOL implantation had similar latest postoperative LogMAR BCVA(<i>t</i>=0.397, <i>P</i>=0.957); however the existence of late complications were related with a worse final visual outcome(<i>t</i>=22.156,<i>P</i><0.001). <p>CONCLUSION: The long-term differences in the visual outcomes and complication profiles after ACIOL at Ⅰ stage or scleral-fixated IOL implantation at Ⅱ stage in a complicated cataract operation are not found when capsular support is inadequate.