Complicated cataracts of the posterior subcapsular zone may be associated with a number os systemic conditions. Cataracts from patients with retinitis pigmentosa, Turner's syndrome, myotonic dystrophy, or those who were taking corticosteroids were examined clinically and pathologically after intracapsular cataract extraction. Two major types of posterior subcapsular opacities were observed: one type had multiple vacuoles, while the other type was a more solid appearing (plaque-like or snowball) opacity clinically. The predominant morphologic counterpart (by light and electron microscopy) of the vacuolar opacity is liquefactive necrosis with aberrantly migrated epithelia cells growing into the cataract. In the plaque-like or snowball opacity, the lens fibers are generally disorganized into round globules. The clinical significance is that the vacuolar-liquified posterior subcapsular cataract may be more easily removed by extracapsular methods than the plaque-like opacity; however, the proliferative cells in the vacuolar type are probably the source of an after-cataract membrane that may require discussion.