Seventy-six corneal transplants performed by one surgeon for pseudophakic bullous keratopathy (PBK) were studied. The mean follow-up was 23 months (range 2-76). Of 41 eyes with lenses left in situ, the mean acuity was 20/45; 60.9% of the eyes saw 20/40 or better. In contrast, the mean acuity for 18 eyes with lens removal and 17 eyes with intraocular lens exchange was 20/52 and 20/62, respectively; 42.8% saw 20/40 or better. Eighty-three percent of all grafts remained clear. Vitreous loss, glaucoma, and cystoid macular edema were more common with eyes with lens removals and exchanges. The type of lens present at transplant for PBK did not affect visual outcome. Although the results were not statistically significant, this study suggests that lenses left in situ are associated with a better visual prognosis, and that there is no difference in the clinical results between aphakic and pseudophakic bullous keratopathy.