BACKGROUND: To explore the changes of iris-trabecular contact (ITC) and intraocular pressure (IOP) in patients who underwent penetrating keratoplasty (PK) during early postoperative period. METHODS: This prospective study finally included 46 eyes of 46 patients who underwent PK or triple surgery. Slit lamp examinations, IOP and anterior segment optical coherence tomography (AS-OCT) scans were examined before surgery, and at one-day, one-week, and one-month follow-ups. The parameters of anterior segment, IOP values and ITC ranges were compared. Additionally, the correlation analyses were performed to reveal risk factors of high IOP and postoperative ITC. RESULTS: The anterior segment underwent a significant reconstruction in the early postoperative period. Preoperative ITC was present in one-third of subjects. ITC significantly decreased on the first postoperative day, but showed marked regression at one-week follow-up. For patients without preoperative ITC, there was a small incidence (10%) of new ITC occurrence. The correlation analysis indicated that the most related factor of postoperative ITC was the presence of preoperative ITC. A high IOP was measured in 15 patients during one month, and it was inclined to occur on the first postoperative day and in patients who accepted triple surgery. CONCLUSIONS: The incidence of new ITC was relatively low, but unfortunately, the preoperative ITC ranges would predominantly reoccur during one month. ITC was not associated with IOP elevation during the early postoperative period in this study. Thus, AS-OCT were helpful to monitor changes of anterior segment and forecast postoperative ITC.