We retrospectively studied 53 consecutive triple procedures (combined penetrating keratoplasty, cataract extraction and intraocular lens implantation) performed at the Bascom Palmer Eye Institute from January 1980 through August 1983. Most patients had at rest six months of follow-up. The final postoperative refractive error was compared to the predicted refractive error using the preoperative axial length and the estimated keratometry readings. The deviation from the predicted refractive error was correlated with the source of preoperative keratometry readings, the degree of donor oversize, and the donor age. We found that using keratometry readings from the operated eye resulted in more accurate intraocular lens calculations than using estimated keratometry readings not obtained from either eye (P less than .05).