Continuous tear capsulotomy and phacoemulsification cataract extraction combined with penetrating keratoplasty

Continuous tear capsulotomy, or capsulorhexis, permits secure and precise placement of a posterior chamber intraocular lens. This technique can be used open sky during triple procedures combining penetrating keratoplasty with cataract extraction and intraocular lens insertion. Expression of the nucleus through a continuous tear capsulotomy can be difficult. Incisions in the anterior capsule facilitate nucleus expression but can extend, obviating the advantages of continuous tear capsulotomy. With phacoemulsification using low irrigation and adequate ultrasound power, the nucleus can be completely emulsified or fragmented into easily removable pieces. This permits continuous tear capsulotomy to be part of triple procedure surgery.