Piggyback minus-power lens implantation in keratoconus

A 53-year-old man with keratoconus and an axial length of 32.59 mm had cataract extraction by phacoemulsification. The Holladay II formula called for -14.00 diopters (D) of power. Two negative-power intraocular lenses (IOLs) were implanted to optimize visual results. A 1 day postoperative refraction of +1.50 D sphere necessitated an exchange of the anterior IOL. Six days after the exchange, the patient had a refraction of -1.25 D sphere and best corrected visual acuity of 20/50.