Background/Objectives: This study assessed outcomes between penetrating keratoplasty (PK) and Descemet’s stripping automated endothelial keratoplasty (DSAEK) when combined with cataract surgery as part of the triple procedure. Methods: Retrospective analysis of 727 triple procedures (525 PK and 202 DSAEK) from 2007–2023. Graft survival, visual acuity, and refractive outcomes were analyzed. Kaplan–Meier and Cox regression were used for survival and prognostic analysis. Results: No statistically significant difference in survival was found (PK—42 months; DSAEK—47 months). DSAEK had better visual acuity improvement and refractive stability. PK had higher astigmatism and variability in refractive error. Conclusions: While graft survival was comparable, DSAEK offers superior visual rehabilitation, supporting its use when refractive predictability is important.