Efficacy of core vitrectomy preceding triple corneal procedure

Abstract

Aims: To evaluate the effectiveness of core vitrectomy preceding triple corneal procedure (penetrating keratoplasty, extracapsular cataract extraction, and intraocular lens (IOL) implantation). Methods: Thirty one consecutive eyes of 31 patients with indication for triple corneal procedure were randomly assigned to either triple procedure with core vitrectomy (vitrectomy group) or without vitrectomy (control group). The success rate of IOL implantation, IOL positioning, intraoperative and postoperative complications, endothelial cell loss, and best corrected visual acuity (BCVA) were compared. Follow up period was six months. Factors that may contribute to vitreous pressure elevation were also investigated in each case. Results: There was no statistically significant difference in each clinical parameter examined except a tendency of facilitating IOL implantation (p = 0.11). There were two cases of vitreous loss in the control group. Retinal detachment was not seen in any of the cases. The body mass index and age were related to higher vitreous pressure (p,0.05). Conclusion: Core vitrectomy preceding triple corneal procedure is not necessary for all cases.

Evaluation of an interlaced triple procedure

“…[ 1 , 3 , 5 , 8 , 13 ] However, traditional triple surgery can involve more risk compared to staged surgery because performing IOL implantation in the open-sky state entails a longer open state duration, which increases the intraoperative risks and difficulty of accurately and safely inserting the IOL into the capsular bag. [ 14 – 20 ] Moreover, the surgical training period associated with traditional triple surgery is prolonged compared to that associated with staged surgery.…”

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

“…When the aqueous loss and hypotony occur simultaneously, a difference arises between the pressure in the vitreous cavity and that in the anterior chamber, so that the pressure in the former, which will be significantly higher than that in the latter, pushes the contents of the vitreous cavity forward (Figs. 3a and 4a), even causing lens dislocation [7,8] ( Figs. 3b and 4b, c).…”

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.…”