We describe the use of long-term dilation and patching therapy in the management of three cases of pediatric monocular cataract. The cataracts were felt to be visually significant in the undilated state but consistent with good formed vision in the dilated state. One patient had a congenital cataract managed from 4 weeks of life, and two patients had late diagnosed cataracts of indeterminate onset presenting with dense deprivation amblyopia. The congenital cataract patient ultimately demonstrated recognition acuity of 20/40, and both the older children ultimately demonstrated an acuity of 20/30. We recommend considering long-term dilation and conventional amblyopia therapy rather than lensectomy in such cases if the cataract is felt to be consistent with development of good formed vision in the dilated state.