We retrospectively studied 61 consecutive cases of penetrating keratoplasty performed for aphakic bullous keratopathy or pseudophakic bullous keratopathy. After keratoplasty, the mean visual acuities of both groups of patients improved significantly from preoperative levels (P less than .0001). One year after keratoplasty, 18 eyes had visual acuities of 20/40 or better. Twelve of the 24 eyes followed up for at least two years after surgery had visual acuities of 20/40 or better. The mean visual acuities for the eyes with aphakic bullous keratopathy and the eyes with pseudophakic bullous keratopathy were not significantly different at either one or two years after keratoplasty. Cystoid macular edema (11 eyes) and glaucoma (12 eyes) were the most common causes of visual acuities worse than 20/40. There were no significant differences in the incidences of these complications in the group with aphakic bullous keratopathy and in the group with pseudophakic bullous keratopathy. Intraocular lens removal did not significantly affect either visual acuity or macular complications after keratoplasty.