Cataract surgery is known to induce refractive and corneal astigmatism, but little is known regarding the specific corneal topographic alterations produced by this surgery. We evaluated the corneal topographic effects of extracapsular cataract extraction (ECCE) performed with an 8- to 11-mm posterior limbal incision closed with interrupted sutures and subsequent selective suture removal. Corneal topography was analyzed in 15 eyes with the TMS-1 videokeratoscope preoperatively, before selective suture removal 4-6 weeks after surgery, 2-5 weeks after selective removal of sutures, and at 5 1/2-8 months after surgery. The Surface Regularity Index was significantly increased before suture removal and after suture removal but returned to normal at the final examination. The Irregular Astigmatism Index remained significantly increased at all examinations after surgery. Corneal asymmetry (Surface Asymmetry Index) continued to be significantly increased compared with the preoperative examination after suture removal and at 6 months after surgery. The standard deviation of powers (SDP) was significantly elevated before and immediately after suture removal, but was not significantly different at 6 months. Mean corneal astigmatism remained significantly increased (0.80 +/- 0.11 preoperatively, 1.39 +/- 0.24 at maximum follow-up, p = 0.04). Significant changes in corneal topography occurred in each patient between suture removal and final examinations. A few patients developed against-the-rule astigmatism ranging from 0.6 to 2.2 diopters. ECCE significantly altered corneal tomography compared with the preoperative contour in all patients. In those patients in whom surgically induced nonspherical and noncylindrical distortions occur (radially asymmetrical power distribution, lack of central corneal smoothness), corneal topography may provide information that is useful for management.