The visual acuity outcome of patients with persistent hyperplastic primary vitreous (PHPV) was reviewed. A total of 48 patients with the diagnosis of PHPV were seen at the University of Iowa, Iowa City, from 1971 through 1984. Twenty-five patients were managed nonsurgically, of which 23 had a poor visual acuity outcome (less than or equal to 5/200). Two with mild cases had visual acuities of 20/100 and 20/30. Twenty-three patients were treated surgically. Five of these had no further postoperative rehabilitation. Eighteen patients underwent surgery and aggressive optical and occlusion therapy. Eight of these 18 patients (44%) had postoperative visual acuities of 20/200 or better. These eight patients represent 17% of the study population. Therefore, lensectomy-membranectomy procedures for the purpose of effecting visual development are reasonable therapeutic options in patients with PHPV in whom the findings are primarily anterior in nature, surgery is performed at an early age, and aggressive amblyopia therapy is instituted.