CLOSED-SYSTEM PHACOEMULSIFICATION AND POSTERIOR CHAMBER IMPLANT COMBINED WITH PENETRATING KERATOPLASTY

The main intraoperative difficulties of performing a procedure combini ng open-sky extracapsular cataract extraction, implantation of posteri or chamber intraocular lens (PC-IOL), and penetrating keratoplasty ('' triple procedure''), most frequently caused by the uncompensated poste rior pressure created when the cornea is open, include incomplete caps ulorhexis, incomplete aspiration-irrigation of the cortex, uncertain p lacing of the IOL, posterior capsule rupture, choroidal effusion, and even expulsive hemorrhage. We recommend a two-step procedure that elim inates these problems: The first step begins with removal of epitheliu m, half-thickness trephining of the cornea, and capsulorhexis; proceed s through phacoemulsification and aspiration-irrigation; and ends with implantation of the PC-IOL, using a pressurized system. The second st ep is penetrating keratoplasty. In the six cases undergoing this proce dure, 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 preclud es the above mentioned intraoperative complications, which could affec t late results.