Corneal transplantation triple procedures

The corneal triple procedure, combining keratoplasty, cataract extraction, and intraocular lens implantation, remains a valuable option for patients with concurrent corneal opacity and cataract. We synthesize historical and contemporary evidence on penetrating keratoplasty (PKP), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK) triple procedures, highlighting their indications, surgical techniques, outcomes, and evolving trends. PKP triple is indicated for full-thickness scarring, keratoconus with central scarring, and cases with anterior segment abnormalities, but remains technically demanding due to open-sky cataract surgery and postoperative refractive unpredictability. ALK triple offers tectonic and visual rehabilitation in stromal disorders sparing the endothelium, though technically challenging. EK triple procedures, particularly Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty, are increasingly preferred in endothelial disorders such as Fuchs endothelial corneal dystrophy, offering faster recovery, more predictable refraction, and better graft survival. Advances in capsulotomy, nucleus management, intraocular lens power calculation, and perioperative strategies have improved safety and refractive outcomes across triple procedures. Long-term studies reveal that although visual and anatomical success rates remain high, complications such as graft rejection, glaucoma, and posterior capsular opacification persist. Careful patient selection and tailored surgical planning are essential, as triple procedures continue to evolve toward safer and more predictable outcomes.