The treatment of choice for cases of corneal opacity with significant cataract is often a triple procedure. However, in certain situations the chances of graft survival are poor, for example in cases with deep vascularization, secondary glaucoma, and healed viral keratitis. Under these circumstances, performing cataract surgery only might improve the visual acuity enough to maintain the patient's day-to-day activities. Performing cataract surgery, especially phacoemulsification, in these cases is challenging. Proper case selection, choosing the right technique, and a thorough idea about the difficulties and methods of tackling such cases is paramount to achieving optimum visual outcomes. In this review, we discuss the case selection and surgical modifications of performing phacoemulsification in cases with coexisting corneal opacities.
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