New endothelial keratoplasty, phacoemulsification, and intraocular lens implantation triple procedure: comparison with conventional triple procedure.

PURPOSE: To compare the clinical outcomes of a new triple procedure comprising endothelial keratoplasty, phacoemulsification, and intraocular lens (IOL) implantation and a conventional triple procedure comprising penetrating keratoplasty, extracapsular cataract extraction, and IOL implantation.

SETTING

Cornea Services, Medical Research Foundation, Chennai, Tamil Nadu, India.

METHODS

In this prospective nonrandomized study, the new triple procedure was performed in eyes with predominant endothelial dysfunction and coexisting cataract and the conventional triple procedure, in eyes with opacities affecting other layers of the cornea. Outcome measures were intraoperative and postoperative complications, 3-month postoperative distance visual acuity, refractive status, mean corneal power, corneal topography, and endothelial cell loss. The outcomes in the 2 groups were compared.

RESULTS

The new procedure group comprised 54 eyes and the conventional procedure group, 26 eyes. All grafts in both groups were clear 3 months postoperatively. The IOL was fixated in the capsular bag in all eyes in the new procedure group and 23% of eyes in the conventional procedure group. Postoperatively, persistent epithelial defects, uveitis, glaucoma, and posterior capsule opacification were significantly more frequent in the conventional procedure group. Visual acuity was significantly better and the postoperative refractive status more predictable in the new procedure group. Endothelial cell loss was greater in the new procedure group than in the conventional group, although the difference was not statistically significant.

CONCLUSION

The new triple procedure was safer than the conventional triple procedure and resulted in better visual outcomes, a more predictable refractive error, a smoother corneal contour, and a tectonically stronger globe.

FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.