[Value of implantation in the capsular bag during combined operation of penetrating keratoplasty and cataract surgery].

PURPOSE

To evaluate the clinical results of the triple procedure performed using phacoemulsification.

METHODS

We prospectively studied 23 consecutive triple procedures carried out during a 3-year period. The average follow-up was 18 months. The main indications for grafting were Fuchs' endothelial dystrophy (30%) and infectious keratitis (26%).

RESULTS

A capsulorrhexis was performed in 70% of the cases whereas a "can opener" was performed in the remaining 30%. A divide and conquer phacoemulsification method was used in 43% of the cases. Hydrodissection was used for lens removing in 27% of the cases. The posterior lens capsule was inadvertently broken and a flexible anterior chamber lens was inserted in one case. Twenty-two posterior chamber lenses were inserted in the capsular bag (16) or in the sulcus (6). The estimated 1-year graft survival was 76.8% overall, and 92.9% when high-risk recipients were excluded. Causes of graft failure were immune rejection (n = 4), persistent epithelial defect (n = 1) and uncontrolled glaucoma (n = 1). The average endothelial density during the second year was 1,401 cell/mm2. Average corrected visual acuity was 20/45 at 12 months. Average astigmatism was 3.9 D. No retinal complication was observed.

CONCLUSIONS

In-the-bag placement of posterior chamber lens is a safe and useful technique during the triple procedure. Phacoemulsification may be useful when the nucleus is hard and voluminous.