Case Description: Here is a very unusual case! This 62 year old man has a cataract and severe keratoconus with a refraction of -20.00 D, -11.00 D of cylinder, and K readings in the 80s! However, he is a very successful hard contact lens wearer and therefore does not require corneal transplantation. I demonstrate how to improve corneal-induced visualization problems during phaco-IOL surgery, and select an IOL with a power that would leave him approximately emmetropic should he eventually undergo transplantation. In the meantime he will remain a successful hard contact lens wearer with improved vision because of the cataract extraction.
Pseudoexfoliation, zonular laxity, poor dilation, a shallow anterior chamber and a convex anterior capsule are all present in this 85 year old patient.