Purpose: To investigate the evolution of postoperative astigmatism after cataract extraction and lens implantation in children through a 6.5 mm limbal incision. Methods: This is a retrospective longitudinal study of consecutive pediatric patients with adequate follow-up who underwent cataract extraction with intraocular lens implantation through a 6.5 mm limbal incision. Preoperative and 3-month postoperative astigmatism and spherical equivalent were compared. Results: A total of 92 eyes of 73 children met the inclusion criteria. The mean cylindrical correction on the first postoperative day was 6.6 ± 2.3 D (range, 1.00-13.00 D). This dropped to 1.9 ± 1.7 D between 2 and 4 weeks and 1.2 ± 1.0 D (range, 0-3.25 D) by 3 months postoperatively. The mean spherical equivalent was +0.5 D on the first postoperative day and did not change significantly during the follow-up period. The mean astigmatism preoperatively (1.2 ± 0.8 D) and 3 months postoperatively (1.2 ± 1.0 D) were not statistically different (p = 0.9). There was no statistically significant change in astigmatism between 1 and 3 months and 1 and 2 years (p = 0.16, n = 33). Conclusions: Large cylindrical refractive errors after pediatric cataract surgery through a 6.5 mm limbal incision resolve postoperatively within 3 months.