Penetrating keratoplasty (PK) is the only definitive treatment for the visual rehabilitation of eyes with pseudophakic bullous keratopathy (PBK). Management of the intraocular lens (IOL) at the time of PK is dependent on lens-related factors and anterior segment abnormalities. We reviewed the results of PK in 81 cases of PBK done at our institute between November 1987 and May 1993. The original lens was an anterior chamber IOL in 26 (32.1%) eyes, iris claw lens in 38 (41.9%) eyes, and a posterior chamber IOL in 17 (20.98%) eyes. IOL explanation alone was done in 24 (29.6%) eyes. The original IOL was retained in 12 (14.9%) eyes and IOL exchange was done in 45 (55.5%) eyes. With a minimum follow-up period of 6 months, the graft remained clear in 54 (66.6%) and the commonest cause of graft failure was graft rejection (17.2%). The best-corrected visual acuity in our series was 20/40 or more in 11 (20.3%) eyes and 20/50 to 20/100 in 30 (55.5%) eyes. We recommend explantation of all closed-loop anterior chamber and iris claw IOLs, and that, anterior chamber reconstruction during PK IOL exchange should be done using a posterior chamber IOL or open-loop Kelman type AC IOL.