Eighty-two eyes of 41 patients with a genetically proven diagnosis of Marfan syndrome were retrospectively analysed. Twenty-seven had bilateral subluxation and 14 received lensectomy. Follow-up was three years. Mean visual acuity (VA) was 0.1 ±0.7 logMAR in patients with normal lens status compared to 0.3 ±0.5 logMAR in subluxed lenses. VA improved from 0.2 ±0.5 logMAR to 0.1 ±0.5 logMAR in children with subluxed lenses but no lensectomy (n=12) and from 0.5 ±0.5 logMAR to 0.2 ±0.5 logMAR in patients who had lensectomy with or without lens implantation. Artisan lenses were the lenses of choice. Children aged two or above were suggested to have primary lenses inserted. The authors indicate that like previous papers on this topic the main limitation is relatively low patient numbers in each category. They find that lensectomy is a safe procedure with only one patient developing macula oedema and another requiring a lens repositioning. The use of iris hooks and capsular tension rings were useful. Similar to any paediatric cataract they state there are many factors that influence if lensectomy is the correct choice.