Between July 1980 and February 1990 we performed 102 penetrating keratoplasties in 102 eyes of 98 patients with pseudophakic bullous keratopathy. Patients were followed up prospectively with an average follow-up of 14 months. 53 of the implant were iris-supported lenses (ISL), 32 were anterior chamber lenses (ACL), and 17 were posterior chamber lenses (PCL) following extracapsular cataract extraction (ECCE). In 88 eyes the intraocular lens implantation had been performed elsewhere. The interval between lens implantation and keratoplasty ranged from 3 to 451 months (mean 59 months) and was significantly shorter (p less than 0.03) for PCL. Eight intraocular lenses had been removed before keratoplasty. During penetrating keratoplasty, 25 lenses were left in place, 49 were removed, and 20 were exchanged. Since 1988, PCL have been implanted and sutured to the iris after removal of the ACL or ISL in 17 eyes that had undergone intracapsular cataract extraction (ICCE). After keratoplasty, visual acuity improved in 95 of the 102 eyes. However, visual acuity was frequently limited by persisting cystoid macular edema. In eyes that had undergone keratoplasty following ECCE and PCL implantation, visual acuity was significantly better (p less than 0.03) and cystoid macula edema was rarer (p = 0.07) than in eyes with ISL or ACL. the prognosis of penetrating keratoplasty for pseudophakic bullous keratopathy is generally good, although visual acuity is often limited postoperatively by cystoid macular edema. The technique of secondary PCL implantation sutured to the iris appears promising for allowing better optic rehabilitation of patients with pseudophakic bullous keratopathy.