Purpose To evaluate the clinical results of the triple procedure perfo
rmed using phacoemulsification. Methods We prospectively studied 23 co
nsecutive triple procedures carried out during a 3-year period. The av
erage follow-up was 18 months. The main indications for grafting were
Fuchs' endothelial dystrophy (30 %) and infectious keratitis (26 %). R
esults A capsulorrhexis was performed in 70 % of the cases whereas a <
<can opener>> was performed in the remaining 30 %. A divide and conque
r phacoemulsification method was used in 43 % of the cases. Hydrodisse
ction tvas used for lens removing in 27 % of the cases. The posterior
lens capsule was inadvertently broken and a flexible anterior chamber
lens was inserted in one case. Twenty-two posterior chamber lenses wer
e inserted in the capsular bag (16) or in the sulcus (6). The estimate
d 1-year graft survival was 76.8 % overall, and 92,9 % when high-risk
recipients were excluded. Causes aft failure were immune rejection (n
= 4), persistent epithelial defect (n I) and z b uncontrolled glaucoma
(n = 1). The average endothelial density during the second year tvas
1,401 cell/mm(2). Average corrected visual acuity was 20/45 at 12 mont
hs. Average astigmatism 1 vas 3.9 D. No retinal complication was obser
ved. Conclusions In-the-bag placement of posterior chamber Lens is a s
afe and useful technique during the triple procedure. Phacoemulsificat
ion may be useful when the nucleus is hard and voluminous.