PURPOSE: On rare occasions, patients with retinopathy of prematurity develop anterior segment ischemia after laser photocoagulation treatment. The purpose of this investigation was to describe the visual outcomes and the risk of phthisis bulbi after lensectomy in patients with history of retinopathy of prematurity laser photocoagulation and attached retinas at the time of lensectomy. METHODS: A retrospective case series including 3 patients who underwent diode laser photocoagulation for retinopathy of prematurity and developed unilateral anterior segment ischemia with subsequent cataract formation, and then phthisis bulbi after uncomplicated lensectomy. RESULTS: Three eyes became phthisical with total retinal detachment after uncomplicated cataract extraction. Signs of anterior segment ischemia were present in all 3 eyes before the cataract extraction, including shallow anterior chamber, corneal edema, iris atrophy, and posterior synechiae. Features of phthisis bulbi did not occur until after cataract extraction. CONCLUSION: Premature patients who require laser photocoagulation for retinopathy of prematurity and develop cataract presumably related to anterior segment ischemia are at high risk for poor visual outcomes. It is important to determine risks when performing lensectomy, especially because of the amblyogenic risk of cataract in an infant and the required visualization for retinal follow-ups.