Closed-system phacoemulsification and posterior chamber implant combined with penetrating keratoplasty

The main intraoperative difficulties of performing a procedure combining open-sky extracapsular cataract extraction, implantation of posterior chamber intraocular lens (PC-IOL), and penetrating keratoplasty ("triple procedure"), most frequently caused by the uncompensated posterior pressure created when the cornea is open, include incomplete capsulorhexis, incomplete aspiration-irrigation of the cortex, uncertain placing of the IOL, posterior capsule rupture, choroidal effusion, and even expulsive hemorrhage. We recommend a two-step procedure that eliminates these problems: The first step begins with removal of epithelium, half-thickness trephining of the cornea, and capsulorhexis; proceeds through phacoemulsification and aspiration-irrigation; and ends with implantation of the PC-IOL, using a pressurized system. The second step is penetrating keratoplasty. In the six cases undergoing this procedure, none of these complications developed or even tended to develop. Although the follow up in these six cases is very short (from 1 to 6 months), the advantage of the technique is that it effectively precludes the above mentioned intraoperative complications, which could affect late results.