A retrospective chart review of 18 consecutive unselected cases of combined penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber lens implantation was performed. Overall, 89% of the grafts remained clear with follow-up between six and 54 months (average 21 months). Visual acuities were 20/50 or better in 61% of the cases and 20/80 or better in 83%. Postoperative complications included two graft failures, two cases of secondary glaucoma, one case of cystoid macular edema, and one case of pupil capture. No patients to date have required a secondary discission.