Corneal triple procedure: Indications, complications, and outcomes - A developing country scenario

Purpose. We report the indications, complications, and outcomes of 104 corn eal triple procedures in our institute. Methods, Patient records of 104 con secutive cases of corneal triple procedure (penetrating keratoplasty with e xtracapsular cataract extraction and intraocular lens implantation) perform ed by experienced corneal surgeons between January 1992 and December 1997 w ere retrospectively reviewed. Relevant preoperative, operative, and postope rative data were collected. The outcome was assessed by the graft clarity a nd visual acuity at the last visit. Survival analysis of these grafts was d etermined by Kaplan-Meier method. Results. Of 104 patients, 70 were men and 34 were women. Mean age of these patients was 48.5 +/- 17.1 years (range, 1-75 years). Corneal scar ring with cataract was the reason for surgery in 69 (66.4%) cases. The intraoperative complications included vitreous upthru st in seven (6.9%) cases and posterior capsular dehiscence in three (2.9%) cases. The most common early postoperative complications were increased int raocular pressure in 19 (18.3%) and increased anterior chamber reaction in 25 (24%) cases. Posterior capsular opacification was seen in 26 (25%), graf t reaction in 15 (14.4%), and secondary glaucoma in 15 (14.4%) cases. These formed the important late postoperative complications. The average postope rative follow-up was 23.7 +/- 17.6 months (range, 1.6-79.4 months); at whic h time 72% of the grafts remained clear. At last follow-up, 40% of patients had a visual acuity of greater than or equal to 20/40. Conclusions, Cornea l scarring with cataract is the most common reason for triple procedure in this part of the world. This is a safe surgical procedure with good graft c larity and reasonable visual recovery.