Beginning in May 1984, we performed penetrating keratoplasties in combination with extracapsular cataract extractions and implantations of posterior chamber lenses in 21 patients. In addition to cataracts, 15 of these elderly patients presented Fuchs' dystrophy and 6 had corneal scars due to infectious or inflammatory corneal diseases. In 2 of the 21 eyes, keratoplasty was a repeat operation because of graft rejection or graft dystrophy. With a mean follow-up of 22 months, visual rehabilitation was satisfactory: 15 patients (71%) achieved a postoperative corrected visual acuity of 6/12 or better. Postoperative deviation from preoperatively calculated refractive lens power--the only major problem--remained within +/- 2 dptr in 95% (20 eyes), with an error of + 4 dptr in 1 eye (5%). In all 21 eyes, clear corneal grafts were obtained. Thus we consider the triple procedure to be the treatment of choice in cataract patients with corneas opacities.