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. 1999 Apr;83(4):458–462. doi: 10.1136/bjo.83.4.458

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

V Borderie 1, O Touzeau 1, T Bourcier 1, S Carvajal-Gonzalez 1, L Laroche 1
PMCID: PMC1723006  PMID: 10434870

Abstract

AIMS—To evaluate the influence of intraocular lens (IOL) placement on triple procedure clinical results and to investigate whether it is appropriate to use phacoemulsification in patients with large lens nucleus.
METHODS—40 consecutive penetrating keratoplasties combined with cataract extraction 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 through 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 capsulorhexis in the remaining 12 patients (48%). The average 12 month visual acuity 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 intraocular 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 average postoperative graft thickness at 18 months was 552 (27) µm in the former group and 650 (29) µm in the latter group (p = 0.04). No significant difference in graft survival, postoperative endothelial cell density, astigmatism, and videokeratoscopic measurements was found between both groups.
CONCLUSION—In the bag placement of the intraocular lens during the triple procedure results in better outcome of transplantation than ciliary sulcus placement of the IOL. Phacoemulsification allows removal of large nuclei through a 5 mm capsulorhexis without performing relaxing incisions out towards the periphery of the capsule.

 Keywords: corneal transplantation; graft survival; intraocular lens; triple procedure; visual acuity

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Figure 1  .

Figure 1  

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Influence of recipient rejection status on graft survival (Kaplan-Meier method). Log rank: p < 0.0001. Multivariate Cox hazards model: p = 0.04. The numbers of patients at risk at the beginning of the curves are indicated at the end of the curves.

Figure 2  .

Figure 2  

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Influence of postoperative lens status on graft survival (Kaplan-Meier method). Log rank: p = 0.004. Multivariate Cox hazards model: p = 0.12. The numbers of patients at risk at the beginning of the curves are indicated at the end of the curves.

Figure 3  .

Figure 3  

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Influence of preoperative diagnosis on graft survival (Kaplan-Meier method). Log rank: p < 0.0001. Multivariate Cox hazards model: p = 0.10. The numbers of patients at risk at the beginning of the curves are indicated at the end of the curves.

Figure 4  .

Figure 4  

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Influence of postoperative lens status on the likelihood for posterior capsule opacification in patients with clear transplant. Log rank: p = 0.07. The numbers of patients at risk at the beginning of the curves are indicated at the end of the curves.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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