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Irregular astigmatism and keratoconus pose distinct challenges in refractive cataract surgery. This video describes a novel technique of combining a small aperture extended depth of focus lens (Apthera IC-8) with a toric implantable collamer lens in a patient with advanced keratoconus, with initial presenting best spectacle-corrected vision of 20/80 and resulting in uncorrected 20/20 vision.