A group of 249 patients undergoing cataract extraction with intraocular lens implantation underwent specular microscopic endothelial cell photographs before surgery and eight weeks, one year, and two years after surgery. The intraocular lenses used were the Shearing posterior chamber lens and the transiridectomy clip lens after extracapsular cataract extraction and the Medallion iris suture lens after intracapsular cataract extraction. Thirty-seven patients who underwent cataract extraction without implantation served as controls. Eight weeks after surgery, there was no statistical difference between the groups with intraocular lenses and the groups without them. One year and two years after surgery, endothelial cell loss had occurred in all groups except the group who underwent extracapsular cataract extraction without intraocular lens implantation--a group in which the patients were younger. The long-term endothelial cell loss was greater after intracapsular cataract extraction and was greater in the presence of an implant. There was statistically more endothelial cell loss with the transiridectomy clip lens than with the posterior chamber lens eight weeks and one year after surgery; the patients with posterior chamber lenses had continued to have more endothelial cell loss during the second postoperative year.