To review the most recent literature regarding the incidence and pathophysiology of phakic intraocular lens (pIOL) associated cataracts, surgical issues and outcomes of combined pIOL explantation/cataract surgery, and the prevention of cataract formation secondary to pIOLs.The overall rate of cataracts secondary to pIOLs is low, but a disproportionate number is associated with posterior chamber pIOLs. All combination pIOL explantation/cataract surgeries resulted in the successful implantation of a posterior chamber intraocular lens in the capsular bag. We present several theories regarding the pathophysiology of anterior subcapsular cataracts secondary to posterior chamber pIOLs. In addition, we present general strategies in performing combination pIOL explantation/cataract surgery. Several methods of preoperative assessment show promise in helping prevent cataracts secondary to pIOLs, including new ultrasound methods for sulcus imaging and preoperative simulations.Although the incidence of cataracts secondary to pIOLs is low, more studies regarding the pathophysiology of this phenomenon and improvement of preoperative assessment are needed, especially for posterior chamber pIOLs.