Purpose: To report the results of a new approach to the 2-stage surgical management of coexisting visually significant corneal opacities and cataract. Methods: A retrospective analysis of eyes with corneal opacities and cataract that were surgically treated with simultaneous penetrat- ing keratoplasty and cataract surgery, followed by secondary intraocular lens (IOL) implantation after removal of corneal sutures, was conducted. The parameters used for assessment were the following: mean percentage of graft endothelial cell loss after IOL implantation, deviation of the postoperative mean spherical equiv- alent from the target refraction, and mean uncorrected distance visual acuity (UDVA). Results: Twenty-nine eyes were included in the study. The mean baseline UDVA was 1.94 6 0.46, and the mean baseline best-corrected distance visual acuity was 1.56 6 0.42. The mean interval between the 2 surgical interventions was 13.3 6 2.2 months. Just before secondary IOL implantation, the mean endothelial cell density was 2198 6 311 cells. The mean percentage of corneal endothelial cell loss was 7.3% at 6 months after IOL implantation (P = 0.16). Before IOL implantation, the mean spherical equivalent was +11.75 6 3.38 D. After IOL implantation, the mean spherical equivalent improved to 20.19 6 0.93 D (P = 0.003) at 6 months. The mean UDVA improved to 0.34 6 0.18 (P = 0.017), whereas the mean corrected distance visual acuity improved to 0.18 6 0.29 at 6 months (P = 0.016). All grafted corneas maintained their clarity until the final follow- up visit. Conclusions: Postponing IOL implantation some months after simultaneous penetrating keratoplasty and cataract extraction has a negligible effect on the corneal graft endothelium and achieves near postoperative target refraction with significant improvement in UDVA.