Closed-system and open-sky capsulorhexis for combined cataract extraction and corneal transplantation

We describe a triple procedure combining corneal transplantation, cataract extraction, and intraocular lens implantation in which the continuous curvi linear capsulorhexis (CCC) is performed in a closed system when corneal tra nsparency is sufficient or using an open-sky method when corneal transparen cy is poor. With the closed system, the CCC is performed first followed by trephination and hydroexpulsion of the nucleus. A Caporossi coaxial forceps is used to reduce the corneal incision to 1.2 mm, preventing the need for sutures. Tunnel formation, which could limit the size of trephination, is a voided. In addition, endothelial cell loss at the periphery of the recipien t cornea is reduced. This technique was performed in 10 eyes without intrao perative complications. With the open-sky method, the CCC is created while counterpressure is applied to the center of the lens with a large spatula, reducing posterior pressure and thus the risk of capsule tear. This techniq ue was performed in 9 eyes without intraoperative complications. (C) 2001 A SCRS and ESCRS.