title: New endothelial keratoplasty, phacoemulsification, and intraocular lens implantation triple procedure: comparison with conventional triple procedure.
abstract: OBJECTIVE
  To compare the clinical outcomes of a new triple procedure comprising endothelial keratoplasty, phacoemulsification, and intraocular lens (IOL) implantation and a conventional triple procedure comprising penetrating keratoplasty, extracapsular cataract extraction, and IOL implantation.
  
  
  METHODS
  Cornea Services, Medical Research Foundation, Chennai, Tamil Nadu, India.
  
  
  METHODS
  In this prospective nonrandomized study, the new triple procedure was performed in eyes with predominant endothelial dysfunction and coexisting cataract and the conventional triple procedure, in eyes with opacities affecting other layers of the cornea. Outcome measures were intraoperative and postoperative complications, 3-month postoperative distance visual acuity, refractive status, mean corneal power, corneal topography, and endothelial cell loss. The outcomes in the 2 groups were compared.
  
  
  RESULTS
  The new procedure group comprised 54 eyes and the conventional procedure group, 26 eyes. All grafts in both groups were clear 3 months postoperatively. The IOL was fixated in the capsular bag in all eyes in the new procedure group and 23% of eyes in the conventional procedure group. Postoperatively, persistent epithelial defects, uveitis, glaucoma, and posterior capsule opacification were significantly more frequent in the conventional procedure group. Visual acuity was significantly better and the postoperative refractive status more predictable in the new procedure group. Endothelial cell loss was greater in the new procedure group than in the conventional group, although the difference was not statistically significant.
  
  
  CONCLUSIONS
  The new triple procedure was safer than the conventional triple procedure and resulted in better visual outcomes, a more predictable refractive error, a smoother corneal contour, and a tectonically stronger globe.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: Medical and Vision Research Foundation, Chennai, Tamil Nadu, India. drpp@snmail.org
authors.forename: Prema
authors.initials: P
authors.lastname: Padmanabhan
authors.forename: Sonali Kisan
authors.initials: SK
authors.lastname: Warade
authors.forename: Kunjal
authors.initials: K
authors.lastname: Sejpal
mesh_terms: D002386:Cataract / Q000150:complications / Q000628:therapy; D002387:Cataract Extraction; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery; D004728:Endothelium, Corneal / Q000637:transplantation*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology