Double-infusion cannula technique for glued fixation of intraocular lens with endothelial keratoplasty

To describe double-infusion cannula technique (DICT) that involves the placement of 2 infusion cannulas in a combined surgical approach of glued intrascleral haptic fixation of intraocular lens (glued IOL) with endothelial keratoplasty (EK) in patients with aphakic bullous keratopathy.

Prospective, single-centre, interventional study.

Five eyes of 5 patients.

The first cannula placed for fluid infusion at pars plana stabilises the globe and facilitates vitrectomy with the glued IOL procedure. Secondary IOL fixation compartmentalises the eye into anterior and posterior chamber and a continuous posterior fluid infusion prevents globe collapse in an already vitrectomized eye. The second cannula is placed at the level of limbus for pressurised air infusion that facilitates an EK procedure. When the donor graft is being unfolded, air infusion is stopped and fluid from the posterior infusion pushes up the iris IOL diaphragm and facilitates graft unfolding.

The mean follow-up was 14 ± 5 months (range 9-21 months). The donor age ranged from 35-57 years, and the mean percentage of endothelial cell loss calculated at 9 months follow-up was 27.32% ± 3.65%. The mean preoperative and postoperative best-corrected visual acuity was 1.02 ± 0.164 and 0.276 ± 0.173 logMAR, respectively (p = 0.000). No incidence of primary graft failure, graft rejection, or retinal detachment was reported during the entire follow-up period in any of the eyes.

DICT prevents hypotony and intraoperative pressure fluctuations, assists graft unrolling, promotes adherence to the recipient bed tissue, and prevents seepage of air into the vitreous cavity and loss of air tamponade in the anterior chamber.