Corneal triple procedure.

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.