Media opacification following pediatric cataract surgery has always been a problematic issue. Despite advances in microsurgical techniques, unique aspects of the anatomy, physiology, and the post-operative inflammatory response in children predispose them to rapid opacification of the visual axis after successful cataract surgery. Considering the importance of media clarity as a prerequisite for proper optical correction and amblyopia therapy, many methods have been proposed for the prevention or treatment of opacification. The choice of a particular surgical technique in a given patient should be made individually. Factors that may influence such a decision include age, cataract type, associated ocular or systemic conditions, follow-up issues, and socioeconomic status. In young children, the method of choice with good long-term results and low complication rate is lensectomy, primary posterior capsulotomy, and anterior vitrectomy. This review article covers media opacification after pediatric cataract surgery in detail.