Aims To investigate the visual and refractive outcomes, safety, efficacy and stability of cataract surgery in eyes with stable keratoconus.

Methods 17 eyes (10 patients) diagnosed as stable keratoconus, aged from 34 to 73 years (56.63±12.47), underwent micro-incision cataract surgery (MICS) followed by implantation of toric intraocular lens (IOL). Seven of them were operated bilaterally and three unilaterally. A complete ophthalmological examination was performed preoperatively and postoperatively. The main outcome measures were: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry and manifest refraction.

Results Sphere changed from −1.77±6.57D (−11.00 to 7.00) preoperatively to 0.08±0.79D (−1.25 to 1.75) postoperatively (p=0.211), and cylinder changed from −2.95±1.71D (−7.00 to −0.75) to −1.40±1.13D (−3.25 to 0.00) (p=0.016). UDVA (logMAR) changed from 1.33±0.95 (0.40 to 2.77) to 0.32±0.38 (0.00 to 1.30) (p=0.008) and CDVA (logMAR) changed from 0.32±0.45 (0.01 to 1.77) to 0.20±0.36 (−0.03 to 1.30) (p=0.013). Efficacy and safety indexes were 1.38±0.58 and 1.17±0.66, respectively. Refraction and corneal topography were stable during the follow-up (9.10±5.54 months, 3–15)

Conclusions MICS surgery using corneal topography data and standard formulas for the calculation of the IOL power is a safe and effective procedure regarding keratometric stability, visual and refractive results.