THE TRIPLE procedure (combined penetrating keratoplasty [PK], cataract extraction, and intraocular lens [IOL] implantation) is a well-established and effective surgical treatment for patients with both corneal and lenticular opacities. First described by Taylor1 in 1976, the procedure has evolved considerably. The prognosis for a clear graft after the triple procedure is excellent, and studies have shown that there is no significant increase in endothelial cell loss when corneal transplantation is combined with cataract surgery. In many instances, combining PK with cataract surgery is preferable to performing these procedures sequentially.