Visual results are reported for 23 cases of keratophakia for the correction of surgical aphakia followed from 12 to 48 months. Seventeen of the 23 patients had final visual acuities of 20/40 or better. The average residual visual overrefraction was 1.87 +/- 1.79 diopters (mean +/- SE), with an increase of postoperative astigmatism of 1.70 +/- 1.33 diopters. Complications included interface deposits and peripheral epithelial deposits that did not interfere with vision. One patient had an anterior chamber penetration and subsequent penetrating keratoplasty, and two patients had lenticules removed because of corneal edema secondary to increased intraocular pressure. The major disadvantages of keratophakia are the complexity of the procedure and the time required (4 to 6 months) to achieve best-corrected spectacle visual acuity. However, because this procedure is extraocular, it is a better choice than secondary intraocular lens implantation for patients who are unilaterally aphakic and for the young patient.