The triple procedure: in the bag placement versus ciliary sulcus placementof the intraocular lens

Aims-To evaluate the influence of intraocular lens (IOL) placement on tripl e procedure clinical results and to investigate whether it is appropriate t o use phacoemulsification in patients with large lens nucleus. Methods-40 consecutive penetrating keratoplasties combined with cataract ex traction performed in a single institution were studied. Whenever possible a capsulorhexis was performed and the IOL was placed into the capsular bag. Phacoemulsification was used when the nucleus was too large to pass throug h the capsulorhexis. Results-Out of 25 patients with an intact capsulorhexis phacoemulsification was used in 13 (52.0%) whereas the entire nucleus passed through the capsu lorhexis in the remaining 12 patients (48%). The average 12 month visual ac uity was 0.46 (SD 0.21) in patients with in the bag IOL (n = 23) and 0.29 ( 0.08) in patients with ciliary sulcus IOL (n = 13) (p = 0.04). Elevated int raocular pressure occurred in 26.1% (6/23) of patients with in the bag IOL and 61.5% (8/13) of patients with ciliary sulcus IOL (p = 0.08). The averag e postoperative graft thickness at 18 months was 552 (27) mu m in the forme r group and 650 (29) mu m in the latter group (p = 0.04). No significant di fference in graft survival, postoperative endothelial cell density, astigma tism, and videokeratoscopic measurements was found between both groups. Conclusion-In the bag placement of the intraocular lens during the triple p rocedure results in better outcome of transplantation than ciliary sulcus p lacement of the IOL. Phacoemulsification allows removal of large nuclei thr ough a 5 mm capsulorhexis without performing relaxing incisions out towards the periphery of the capsule.