Suture removal following penetrating keratoplasty continues to plague surgeons as one of the most unpredictable aspects of this procedure. The patients presented here will detail three cases of endophthalmitis and one case of expulsive hemorrhage following suture removal. These events cannot be predicted. However, certain steps can be taken to minimize these potentially blinding complications. These steps include avoidance of through and through sutures, follow-up examination within 24 h of suture removal to look for signs of wound leak, graft dehiscence or infection, use of appropriate antibiotics, elimination of dacryocystitis prior to keratoplasty, and particular vigilance in immunocompromised patients.