Achieving near normal vision following unilateral congenital cataract surgery is possible but requires early surgery, optical correction and consistent patching. Patching is often challenging for children and their caregivers. The goal of these analyses is to examine the association between reported consistency in patching during the first year after surgery and visual acuity.

A previously healthy teenage boy presented with progressive decreased vision in both eyes over 1 year. His visual acuity was hand motion in both eyes. The slit-lamp examination revealed bilateral total white cataracts (A and B). Ultrasound biometry showed a relative loss of lens volume of the right eye (C), and intracapsular fluid spaces and increased anteroposterior lens thickness in the left eye (D). Medical evaluation revealed diabetes mellitus type 1 and diabetic ketoacidosis. Ultrasound biometry is useful in detecting lens volume loss in hypermature pediatric cataracts and may decrease the risk of inadvertent posterior capsular trauma intraoperatively.