Evaluation of an interlaced triple procedure: penetrating keratoplasty, extracapsular cataract extraction, and nonopen-sky intraocular lens implantation

Abstract

To evaluate an interlaced triple procedure that involved penetrating keratoplasty (PKP), extracapsular cataract extraction (ECCE) using diathermy capsulotomy, and nonopen-sky intraocular lens (IOL) implantation.This retrospective study involved data from 34 patients who were diagnosed with severe corneal opacities and cataracts. These patients were divided into an interlaced procedure group (21 patients) and a traditional procedure group (13 patients). In the interlaced group, the method of continuous curvilinear capsulorhexis (CCC) was completed via diathermy capsulotomy. The donor corneal button was sutured at 8 positions (at equal intervals) using 10-0 nylon sutures, and the IOL was inserted into the capsular bag using a closed anterior chamber approach at the 10:30 to 12 o'clock positions between the sutures. In the traditional group, CCC was completed using side-port capsular forceps, and the IOL was implanted using an open anterior chamber approach.In the interlaced group, the CCC, open-sky, and total operation times were significantly shorter than in the traditional group (P < .05). Neither the best-corrected visual acuity (BCVA) nor corneal endothelial cell density was significantly different between the groups at 1 and 6 months after the operation.This interlaced triple procedure for the treatment of corneal diseases with cataracts appears to be feasible and practical.

Figure 1

Surgical procedure. (A) Suturing of Flieringa ring. (B, C) Positions of dye. (D) Use of the Hessburg–Barron vacuum trephine. (E, F) Removal of the recipient's cornea. (G) CCC using diathermy capsulotomy. (H) ECCE. (I, J) Suturing of the donor corneal button at eight positions. (K) Insertion of IOL at the 10:30 and 12 o’clock positions. (L) Suturing of the remnant corneal button. CCC = continuous curvilinear capsulorhexis, ECCE = extracapsular cataract extraction, IOL = intraocular lens.

Figure 2

Postoperative results of a representative patient visualized using ultrasound biomicroscopy. The anterior chamber angle was open, and the IOL was accurately inserted into the capsular bag. IOL = intraocular lens.

Figure 3

Photographs of anterior segment in a representative patient. (A) Preoperative, (B) postoperative (at 6 months), showing that the donor corneal button remained transparent.