OBJECTIVE: To assess primary intraocular lens (IOL) insertion within 24 hours of penetrating ocular injury involving penetration of both the cornea and the posterior lens capsule (and intervening structures). The surgical technique comprises cataract aspiration, vitrectomy, closed microsurgical intraocular foreign body (IOFB) removal (in most cases) and IOL insertion in a single procedure. STUDY DESIGN: Prospective study of postoperative results for up to 34 months after surgery. SETTING: The casualty, theatre and out-patient departments of the Princess Alexandra Eye Pavilion, Edinburgh. PATIENTS: Seven patients presenting as emergencies with penetrating ocular trauma ± IOFB underwent this procedure; patient selection was determined by the degree of anterior and posterior segment disruption by trauma. MAIN OUTCOME MEASURES: Corrected visual acuity; complications. RESULTS: All cases achieved good vision (± correction) and early visual rehabilitation, without serious complications during the follow-up period. CONCLUSIONS: Combined wound repair, cataract extraction, vitrectomy, closed microsurgical IOFB removal and IOL insertion (within one day of injury) offer a favourable alternative to the current practice of primary wound repair and/or IOFB removal followed by a second operation for cataract extraction and/or IOL insertion at a later date.