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Purpose: We report a case of cataract surgery in a patient with a detectable angle gamma due to macular heterotopia., Observation: A 48-year-old man had angle gamma due to macular heterotopia secondary to retinopathy of prematurity. The preoperative corrected distance visual acuity was 20/32 in the right eye and 20/200 in the left eye. Ocular deviation was esotropic at an angle of 70-80prism diopter. Only the right eye was capable of fixating due to the amblyopia in the left eye. The preoperative root mean square was measured (cornea: 1.32 μm, total: 1.64 μm in ordinary fixation position, cornea: 0.36 μm, total: 3.40 μm in pupil center position). The total aberration was lower in the ordinary fixation position than in the pupil center position. Corneal refractive power was 41.75 D in the ordinary fixation position and 43.05 D in the pupil center position. The axial lengths were 22.25 and 22.54 mm, respectively. We selected the VA60BBR intraocular lens (IOL) at +28.00 D based on the targeted fixation state. Target refraction was -1.32 D. The postoperative course was favorable, and the resulting visual acuity was 20/40., Conclusion: We report a case of cataract surgery on a patient with an angle gamma due to macular heterotopia. The postoperative course was favorable, and the patient's satisfaction was good considering that we selected the IOL's postoperative fixation state to meet the patient's occupational demands.