Triple procedure: cataract extraction, intraocular lens implantation, and corneal graft

Corneal triple procedures consist of combined keratoplasty surgery and cataract surgery. Currently, anterior lamellar keratoplasty, endothelial keratoplasty, and conventional penetrating keratoplasty, are very often simultaneously performed with cataract surgery. The present article reviews the recent advances and current developments in corneal triple procedures.

Many new findings have been reported. Core vitrectomy before host trephination and retroillumination during continuous curvilinear capsulorhexis has enabled us to perform penetrating keratoplasty triple procedures more safely. Type-1 big-bubble, baring Dua's layer, facilitates well tolerated anterior lamellar triple keratoplasty without Descemet membrane perforation. Descemet membrane endothelial keratoplasty triple procedure can provide excellent expected postoperative refraction. New techniques, including manual medium incision cataract surgery or glued intrascleral fixation of the intraocular lens with pupilloplasty, can be used for endothelial keratoplasty triple procedure, and frequent topical steroid administration can contribute to the reduction of postoperative cystoid macular edema.

Recent technical advancements could contribute to safer and more effective corneal triple procedures. Triple surgery combined with novel procedures, including regenerative medicine and bioengineered corneal transplantation, will be performed in the near future.