PURPOSE: The purpose of this study is to present the clinico-demographic characteristics of pseudophakic bullous keratopathy (PBK), its visual outcomes, factors associated with the choice of treatment, and poor visual outcomes of PBK. METHODS: In this hospital-based retrospective study, electronic medical records data of new patients who presented to a multi-tier ophthalmology hospital network in India (November 2010-June 2022) were extracted. Patients with at least 4 weeks of follow-up were analyzed for visual outcome data. Bivariate analysis and multivariate logistic regression were used to determine the factors associated with the treatment choice and poor visual outcomes. RESULTS: Of the 3,323,247 electronic records (with an average follow-up of 293 days) examined, 10,522 eyes of 10,158 patients (0.3%) had PBK. The majority were managed non-surgically ( n = 7372
70.1%), with increased odds of poor visual outcome by 3.46 times (AdjOR: 3.04-3.92, P <
0.002). Those belonging to the non-paying category had higher odds of poor visual outcome (AdjOR: 1.48, 95%CI: 1.29-1.69
P <
0.002). Surgical management improved vision by 0.72 logMAR (95%CI: 0.60-0.73
P <
0.002). A total of 41.2% ( n = 113/274) of cases that underwent Descemet's membrane endothelial keratoplasty and 18.4% ( n = 285/1551) of Descemet's stripping endothelial keratoplasty attained last follow-up visual acuity (LVA) of 6/18 or better. CONCLUSION: About three in every thousand patients had PBK. Surgical interventions improved visual acuity significantly. About four in ten patients who underwent DMEK attained a vision of 6/18 or better at the last follow-up visit. Markers of lower socioeconomic strata were independently associated with poor visual outcomes.