The sequential procedure (cataract surgery a few months after keratoplasty) provides better functional and refractive performance due to graft stabilization and more accurate biometrics used to calculate the IOL. For the triple procedure, the highest functional results are ensured by the fixed keratometric values of 42.5-44.0 D in the IOL calculation and allow achieving the target refraction in 26-68% of cases. In cases with a sequential technique, actual keratotopography is preferred, while achieving the target refraction in 67-95% of cases. The astigmatism problem successfully solved by implantation of toric IOLs and/or corneal refractive surgery. In refractive changes occur after a triple procedure or after delayed cataract surgery, the technology of implantation of additional toric IOLs or refractive excimer laser surgery comes to the rescue. Implantation of trifocal or EDOF lenses based on a diffraction grating is contraindicated for patients after keratoplasty. The promising direction may be IOL with an increased depth of focus implantation, such as Alcon's AcrySof IQ Vivity, with the optic that has a tolerance for a small deviation from the specified emmetropia from +0.5 to -0.5 D, which reduces the chance of refractive errors.

Purpose. The article presents a clinical case of cataract surgery with implantation and preoperative calculation of the AcrySof IQ Vivity intraocular lens (IOL) (Alcon, USA) in a patient who underwent penetrating keratoplasty 15 months ago. Material and methods. IOL calculation was based on the actual data of the optical biometry, keratotopographic measurements. Considering complaints, a decrease in the quality of life, ophthalmic status data, it was decided to perform a penetrating subtotal keratoplasty of the right eye, followed by remote phacoemulsification and implantation of an intraocular lens. Results. Patient reports good quality of vision at a distance and average distance; does not experience difficulties when working with computer, feels comfortable while driving at night. Conclusion. Delayed cataract surgery with IOL implantation with the wavefront formation mechanism after penetrating subtotal keratoplasty, only in cases of donor material stabilization, allows to get accurate refraction. Even despite the high probability of refractive error, this type and design features of the lens made it possible to obtain the optimal quality of vision for the patient. Keywords: penetrating keratoplasty, cataract, intraocular lens, refractive error.