gms | German Medical Science

The combination of perforating keratoplasty, extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) has become the preferred surgical technique in patients with combined corneal disease and cataract in the last decades. We report on our postoperative results in patients with problematical preoperative corneal conditions.

Between 1997 and 2003 a triple procedure was performed in 14 patients (14 eyes) with postinflammatory corneal perforation and in high risk situations such as deep corneal vascularisation (>2 quadrants) or re-keratoplasty. The median postoperative follow-up was 9 months (6-48 month). Patients with high risk keratoplasty were immunosuppressed postoperatively with cyclosporine A systemically.

The median preoperative visual acuity (VA) was hand movements (LP-20/60). Postoperatively, a clear transplant could be observed in 71% of patients. The best corrected spectacle VA ranged from LP to 20/40 (median 20/80) and reached high significance compared to preoperative VA (p=0.002). Reading VA ≥20/50 was obtained in 36% of patients. VA limiting factors included amblyopia (1 eye), high myopia (1 eye), and postoperative complications such as ulcer/infiltrate in the transplant (3 eyes) and glaucoma (1 eye).

Triple procedures are feasible even in complex corneal situations with satisfactory functional results.