A series of 795 primary intraocular lens (IOL) implantations performed at the Wilmer Institute during the past 6 years by two surgeons were reviewed. Progressive corneal endothelial-cell loss and an increased rate of late-onset corneal edema were detected in the group with the Morcher (European) four-loop iris-clip Binkhorst IOLs. Clinically significant cystoid macular edema was more frequent in eyes with the American four-loop Binkhorst lens, presumably due to chronic iritis caused by contaminants on the IOLs. Our short-term results with the American Shearing-type IOLs implanted at the time of extracapsular cataract extraction are encouraging, with 98% of the cases achieving 20/40 vision or better, excluding those with known macular degeneration or amblyopia. A continued cautious approach to IOL implantation is recommended.