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The experiment was designed to illustrate the difference between the diamond knife and the excimer laser (ArF 193 nm) on keratotomy incisions. The histopathologic effect of fibronectin applied to these wounds was observed. Fibronectin demonstrated a chemotactic effect on fibroblasts and increased the amount of newly synthesized collagen deposited at the incision sites. The excimer laser incisions treated with fibronectin had 43% more fibroblasts per 2,500 microns 2 than the excimer laser incisions not treated with fibronectin. The adjustable diamond knife incisions treated with fibronectin had 42% more fibroblasts than the adjustable diamond knife incisions not treated with fibronectin. The excimer laser ArF 193 nm incisions had 18% more fibroblasts in the incision area than the adjustable diamond knife incisions independent of fibronectin usage. This indicates that the excimer laser incisions and the diamond knife incisions may have different healing mechanisms--perhaps because of the distinctive modes of action of these instruments.

The triple procedure (penetrating keratoplasty, cataract extraction, and intraocular lens implantation) performed using endocapsular cataract extraction and posterior chamber intraocular lens implantation offers advantages over the extracapsular technique. The most significant advantage is easier, assured placement of the posterior chamber intraocular lens entirely in the bag. Another advantage is less chance of injury to the endothelial cells. This paper describes a technique using endocapsular cataract extraction in the triple procedure.