Background: Pterygium and cataract are two of the most common ocular pathologies encountered in tropical and subtropical regions. Their coexistence presents a surgical challenge because pterygium induces corneal astigmatism and alters keratometric readings, which directly affects intraocular lens power calculation during cataract surgery. The decision to perform simultaneous surgery or a staged sequential approach remains controversial. Objective: To compare visual outcomes and refractive status in patients undergoing simultaneous pterygium excision with cataract surgery versus sequential pterygium excision followed by cataract surgery after corneal stabilization. Methods: This prospective interventional comparative study included 50 patients with grade II pterygium and senile cataract. Patients were divided into two groups: simultaneous surgery (n=25) and sequential surgery (n=25). Preoperative and postoperative visual acuity, keratometric parameters, and spherical equivalent were evaluated up to 4 weeks. Statistical analysis was performed using SPSS 25.0 software, and p-values <0.05 were considered significant. Results: Both groups showed significant improvement in uncorrected and best corrected visual acuity. However, sequential surgery demonstrated superior refractive predictability with significantly lower residual spherical equivalent (p=0.013). Keratometric stabilization was more consistent in the sequential group.