Corneal triple procedure

Abstract

Corneal diseases subject to keratoplasty are often combined with a certain degree of cataract. Therefore, appropriate strategies for the management of cataract are mandatory. One strategy is a sequential procedure performing cataract surgery after keratoplasty. Though this procedure enables us to estimate IOL power accurately, there are several drawbacks including multiple procedures, slow visual rehabilitation and endothelial damage during cataract surgery. On the other hand, triple procedure, consisting of penetrating keratoplasty, extracapsular lens extraction and IOL implantation, has several advantages, such as single procedure, rapid visual rehabilitation and no additional endothelial trauma. How-ever, open sky procedure may be accompanied by uncontrollable vitreous pressure followed by posterior capsule rupture and difficulty of IOL implantation, while the worst outcome may be expulsive hemorrhage. Combined core vitrectomy preceding corneal trephination is contrived to solve this problem. This procedure is simply performed from a single sclerotomy 3.5-4.01 mm posterior to the corneal limbus with a vitreous cutter under the external pressure to the eye, and vitreous pressure is sufficiently lowered to allow the following procedures to be done very safely. Another problem with triple procedure is the calculation of IOL power. This problem is caused by unpredictable keratometer readings after keratoplasty. Several methods for calculating IOL power in triple procedure are also discussed.

Cataract Surgery With Toric Intraocular Lenses Can Optimize Uncorrected Postoperative Visual Acuity in Patients With Marked Corneal Astigmatism

“…Estimates have been made, and although they have to be adapted for individual surgeons, they remain somewhat unpredictable. 2,6,7 The main arguments in favor of the triple procedure are the relatively short visual recovery time, the reduced number of separate procedures, and the potential problem of endothelial loss occurring during a separate cataract procedure.…”

Results of Penetrating Keratoplasty Triple Procedure With 25-gauge Core Vitrectomy

“…[6][7][8][9][10][11][12][13] When the IOL is inserted, frequently the posterior capsule will not be lowered, even though a viscoelastic solution is applied onto the capsular bag, and the elevated posterior capsular bag can pose a risk to the IOL insertion. This, however, can be solved by performing core vitrectomy for 1 minute to lower the posterior capsule, and the risk of capsule rupture during cortex aspiration can be reduced.…”

“…However, ophthalmologists face several challenges in performing the PKP triple procedure safely, for example, to aspirate residual cortex without rupturing the posterior capsule and to successfully implant an IOL under the open-sky condition. [6][7][8][9][10][11][12][13] When vitreous pressure is elevated, cortex aspiration may easily cause capsule rupture, and IOL implantation becomes increasingly difficult. [6][7][8][9][10][11][12][13] It is therefore essential to reduce vitreous pressure preoperatively for a safe PKP triple procedure.…”

Toxic Anterior Segment Syndrome following a Triple Descemet’s Stripping Automated Endothelial Keratoplasty Procedure

“…In patients requiring both cataract extraction and endothelial keratoplasty, a Descemet's stripping automated endothelial keratoplasty (DSAEK) triple procedure, consisting of phacoemulsification and intraocular lens (IOL) implantation, followed by DSAEK, may be the procedure of choice [2]. …”