Cataract surgery in cases with previous corneal surgery can be a major challenge for the ophthalmologist as the visual and refractive outcome can be seriously affected. The surgeon has to preoperatively evaluate whether it is the cataract or the previous corneal surgery that most affects the visual acuity. The surgical procedure should be then carefully planned, to evaluate if a corneal graft surgery should be performed coincidentally to the cataract procedure or whether cataract surgery alone may sufficiently restore the best corrected vision of the patient. If phacoemulsification is possible, it is better to perform cataract surgery first to avoid risks which may occur with simultaneous surgery. Keratoplasty should be postponed to a later date. The refractive outcome of the case deserves special attention in the preoperative planning process and the reduction or elimination of the already existing astigmatism will be a desirable result. The authors will try to provide the practical cataract surgeon a review on this topic aiming to give guidelines for good clinical practice in the decision making process of these challenging and difficult cases.