The aim of this study was to quantify the complexity of contact lens (CL) fitting following penetrating keratoplasty (PKP).The CL care of 40 eyes following PKP was analyzed retrospectively and compared to that of 40 age-matched and gender-matched controls. We evaluated the numbers of diagnostic and ordered rigid gas permeable (RGP) CLs, office visits for 6-month follow-up, best spectacle and RGP CL-corrected logMar visual acuities (VAs), and RGP CL success and complication rates. Post-PKP corneas required more diagnostic CLs (p = 0.009), ordered CLs (p = 0.0003), and office visits (p = 0.001) than did controls. Corrected logMAR VAs post-PKP improved from 0.31 +/- 0.31 (mean +/- SD) with spectacles (20/41) to 0.076 +/- 0.19 (20/24) with RGP CLs (p < 0.0001). Controls logMAR spectacle and CL-corrected VAs were 0.0043 +/- 0.12 (20/20) and -0.023 +/- 0.058 (20/19), respectively (no significant difference, p = 0.096). Ninety percent of PKP eyes and 100% of controls were successful, and 30% of PKP and 12.5% controls had CL-related complications; these differences did not reach statistical significance.Post-PKP eyes require more diagnostic CLs, ordered CLs, and professional office visits. They also have greater improvement of VAs with RGPs than normals compared to spectacles. CL wear post-PKP does not statistically increase the rate of CL complications or alter the success rate of CL wear.