Of 65 consecutive patients (130 eyes) with Vogt-Koyanagi-Harada syndrome, 26 (40%) developed cataracts (49 eyes, 38%). Twenty-eight cataracts were posterior subcapsular, six nuclear, 14 combined nuclear and posterior subcapsular, and one anterior cortical. Risk factors for the development of cataracts included age (P = .003), long-standing recurrent anterior segment inflammation (P < .001), and systemic corticosteroid therapy for six months or more (P < .001). After at least three months of minimal to no intraocular inflammation, 19 eyes underwent cataract extraction, of which 11 also had posterior chamber intraocular lens implantation. Median visual acuity improved significantly from 20/400 to 20/40 (P < .01) after a median follow-up time of 13 months. Route of preoperative corticosteroids, pars plana vitrectomy, and glaucoma surgery did not markedly affect visual prognosis. If preoperative intraocular inflammation is rigorously controlled, cataract surgery can be performed safely and can result in significant visual improvement in patients with Vogt-Koyanagi-Harada syndrome.