Purpose <p>To Compare the visual outcomes of posterior chamber phakic intraocular lens (PCpIOL) implantation in keratoconus (KC) and normal eyes.</p> Methods <p>Patients with KC (cases) and normal eyes (controls) who underwent PCpIOL implantation were analyzed. Eyes with stable KC were included if they had a corrected distance visual acuity (CDVA) ≥ 20/50 and at least 6&#xa0;months of followup. Pathologies other than KC were excluded. Outcomes such as uncorrected distance visual acuity (UDVA), residual sphere, cylinder, spherical equivalent (SE), predictability, efficacy and safety index were calculated. Adverse events if any were reported.</p> Results <p>Twenty-eight eyes of 16 patients were included as cases and 40 eyes of 21 patients served as controls. At 6-month follow-up there was no statistically significant difference between cases and controls in UDVA (<i>p</i> = 0.99), residual sphere (<i>p</i> = 0.36), cylinder (<i>p</i> = 0.09) and SE (<i>p</i> = 0.93). Safety index was 1.17 ± 0.36 and 1.15 ± 0.22 while efficacy index was 1.04 ± 0.32 and 0.93 ± 0.22 in the case and control group respectively. A total of 4 eyes, 2 each in both the groups required a second surgical intervention. Of these, 2 eyes required repositioning of rotated PCpIOL (1 in each group), 1 eye developed cataract in the controls group, and 1 eye had a high vault in the cases necessitating PCpIOL exchange.</p> Conclusions <p>We did not observe a statistically significant difference in visual and refractive outcomes between keratoconus and normal eyes following PCpIOL implantation.</p>