Penetrating keratoplasty (PKP) patients often have severe, visually disabling refractive errors. Astigmatism can be addressed by refractive surgery; however, correcting hyperopia is more problematic. Although pseudophakic PKP patients can have a lens exchange, it can be traumatic in this population. In this pseudophakic PKP patient, I added a second posterior chamber intraocular lens, correcting the hyperopia and resolving visual complaints.