Nine cases of intraoperative expulsive suprachoroidal hemorrhage occurred in a series of 2011 consecutive penetrating keratoplasties (an incidence of 0.45%). In four cases, the complication was directly related to the anesthesia technique. The incidence of hemorrhage was 1.0% in the eyes with preoperative anterior chamber intraocular lenses (IOLs), an incidence significantly higher than for any other associated condition (P < .02). Four of the nine patients recovered a postoperative visual acuity of 20/70 or better. We discuss reasons for the relatively high incidence of hemorrhage during penetrating keratoplasty; its occurrence in relation to the type of anesthesia used, prior intraocular surgery, types of surgery performed together with the penetrating keratoplasty, and the presence of an anterior chamber IOL; and the risks introduced by hemorrhage in a fellow eye and by a previous hemorrhage in the same eye.