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August 2001

In Favor of the Triple Procedure

Arch Ophthalmol. 2001;119(8):1224. doi:

In reply

I agree with E. S. Malbran and colleagues that one of the most dangerous aspects of the combined triple procedure is the period during which the cataract is removed using an open sky approach. They offer an alternative technique1 whereby phacoemulsification is performed either via the graft-host junction through an incompletely trephined donor button or through a separate limbal incision. Although this approach offers the opportunity to remove the cataract within a closed system, there are several concerns. The first is visualization of the anterior segment. With mild or moderate corneal edema or in patients with keratoconus, it may be possible to perform capsulorrhexis and phacoemulsification with intraocular lens implantation through a de-epithelialized, slightly edematous cornea. With more significant corneal opacities, however, such as those seen in stromal scarring or lipid keratopathy, visualization of the capsule and lens is frequently not sufficient to allow safe phacoemulsification. In these situations, cataract removal as part of a staged procedure, performed with a clear cornea that provides an optimal view of the lens capsule and cataract, is preferred.

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