The medical records of 33 patients with dense bilateral congenital cataracts were analyzed for factors affecting visual outcome. The average postoperative follow-up was 6.3 years. Of the 23 patients tested with optotypes (verbal children), 14 had visual acuities of 20/80 or better. Eight patients had binocular vision. Preoperative nystagmus, age at surgery, microphthalmos, and postoperative strabismus were not prognostically significant in visual outcome. Postoperative nystagmus was common and was not indicative of a poor visual outcome. Ocular anomalies, systemic anomalies, and postoperative complications were associated with a lower percentage of good postoperative visual acuities.