title: Anterior vitreous tapping to manage positive vitreous pressure during triple procedures.
abstract: OBJECTIVE
  To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK) combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications.
  
  
  METHODS
  Nonrandomized prospective noncomparative interventional case series.
  
  
  METHODS
  Sixty-five patients who underwent triple procedures between June 2001 and September 2003.
  
  
  METHODS
  Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination, anterior vitreous tapping was performed with a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant.
  
  
  METHODS
  Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous, intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 months.
  
  
  RESULTS
  Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6+/-2.6 months (range, 6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8% had a postoperative BCVA of > or =20/160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed.
  
  
  CONCLUSIONS
  Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications.
authors.affiliation: Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Anun
authors.initials: A
authors.lastname: Vongthongsri
authors.forename: Warintorn
authors.initials: W
authors.lastname: Jakpaiwong
authors.forename: Apiradee
authors.initials: A
authors.lastname: Preechanon
authors.forename: Kaevalin
authors.initials: K
authors.lastname: Lekhanont
authors.forename: Roy S
authors.initials: RS
authors.lastname: Chuck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating / Q000379:methods*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D014792:Visual Acuity; D014822:Vitreous Body / Q000601:surgery*