With the evolution of endothelial keratoplasty, surgical approaches in patient with cataracts and coexisting corneal endotheliopathies have also changed. This article aims to review the factors that determine proper procedure selection, preoperative planning, and surgical modifications during phacoemulsification in order to optimize visual outcomes and avoid surgical pitfalls. The selection of either simultaneous cataract surgery and keratoplasty or staged procedures depends on the patient’s history and clinical exam, desired refractive outcomes, the surgeon’s expertise, and individual preferences.