Purpose The aim was to compare the refractive and visual outcome of the triple procedure and the sequential surgery and to report any adverse effects or complications of each approach. Patients and methods Forty eyes of 40 patients with corneal opacity and visually significant cataract were divided into two equal groups: the triple group (group I) and the sequential group (group II). In group I, patients underwent PKP with cataract extraction by either open sky ECCE technique or phacoemulsification according to the degree of corneal clarity. In group II, patients first underwent PKP then scheduled for phacoemulsification and intraocular lens implantation. All patients were followed up for 1 year, and data including the visual acuity, refractive outcome, ECC and complications were recorded and analyzed. Pkp penetrating keratoplasty ECCE extracapsular catarct extraction Results After 1 year of follow-up, the mean best corrected visual acuity (BSCVA) was 0.35 ±0.13, with 45% of eyes with BSCVA greater than or equal to 0.5 in group I. In group II, the mean BSCVA was 0.52±0.12 (P=0.021), with 60% of eyes with BSCVA greater than or equal to 0.5(P=0.14). Mean spherical equivalent after triple procedure was −1.6±0.2D. Mean spherical equivalent following sequential surgery was −0.29±0.24 D (P=0.00). The mean cylinder after combined surgery was −3.85±1.21, compared with −3.45±0.82 D after sequential surgery (P=0.231). Overall, 50% of group I and 70.0% of group II patients were within ±2 D of the target refraction (P=0.19). No significant difference in the mean ECC was found at the end of follow-up period (P=0.524). Conclusion Planned phacoemulsification after PKP is a safe and effective approach for management of coexisting lens and corneal opacity.