J Korean Ophthalmol Soc.  2011 Aug;52(8):916-921. 10.3341/jkos.2011.52.8.916.

The Effect of Intraocular Lens Insertion Sequence during the Triple Procedure on Corneal Endothelial Cell Survival

Affiliations
  • 1Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. mskim@catholic.ac.kr

Abstract

PURPOSE
To evaluate the differences in corneal endothelial cell density in patients undergoing intraocular lens insertion at 2 different sequences during the triple procedure.
METHODS
The present retrospective study divided 37 eyes of 37 patients and into 2 groups: trephination, phacoemulsification and intraocular insertion, followed by graft suturing (20 eyes, Group I), and trephination, phacoemulsification, graft suturing leaving 3 mm gap, followed by intraocular lens insertion and suturing of the gap (17 eyes, Group II). Intraocular pressure, corneal thickness, and endothelial cell density were measured for 3 months postoperatively.
RESULTS
No significant difference in intraocular pressure between the 2 groups (p = 0.14) was observed. However in Group II, the mean corneal thickness showed a greater decrease (p = 0.02) during the 3 months following surgery, and the mean corneal endothelial cell density in this group was higher at 1, 2, and 3 months postoperatively than that of Group I (p = 0.01, 0.02 and 0.04 respectively). There were no significant difference in the rate of endothelial cell loss during the postoperative period between the 2 groups.
CONCLUSIONS
The anterior chamber formation before intraocular lens insertion in the triple procedure is hypothesized to decrease corneal endothelial cell loss by minimizing mechanical contact with intraocular structures or intraocular lenses during surgery.

Keyword

Anterior chamber formation; Corneal endothelial cell density; Mechanical contact; Triple surgery

MeSH Terms

Anterior Chamber
Corneal Endothelial Cell Loss
Endothelial Cells
Eye
Humans
Intraocular Pressure
Lenses, Intraocular
Phacoemulsification
Postoperative Period
Retrospective Studies
Transplants

Figure

  • Figure 1. Comparison of preoperative and postoperative corneal central thickness in Group I and II.

  • Figure 2. Comparison of preoperative and postoperative corneal endothelial cell density in Group I and II.


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Seung Yong Choi, Soon Il Choi, Sung A Lim, Man Soo Kim
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Reference

References

1. Katzin HM, Meltzer JF. Combined surgery for corneal transplantation and cataract extraction. Am J Ophthalmol. 1966; 62:556–60.
Article
2. Taylor DM. Keratoplasty and intraocular lenses. Ophthalmic Surg. 1976; 7:31–42.
Article
3. Taylor DM, Khaliq A. Keratoplasty and intraocular lenses: follow-up study. Ophthalmic Surg. 1977; 8:49–57.
Article
4. Taylor DM, Khaliq A, Maxwell R. Keratoplasty and intraocular lenses: current status. Ophthalmology. 1979; 86:242–55.
Article
5. Hunkeler JD, Hyde LL. The triple procedure: combined penetrating keratoplasty, extracapsular cataract extraction and lens implantation. An expanded experience. J Am Intraocul Implant Soc. 1983; 9:20–4.
Article
6. Skorpik C, Menapace R, Gnad HD, Grasl M. The triple procedure– results in cataract patients with corneal opacity. Ophthalmologica. 1988; 196:1–6.
7. Binder PS. The triple procedure. Refractive results. 1985 update. Ophthalmology. 1986; 93:1482–8.
8. Meyer RF, Musch DC. Assessment of success and complications of triple procedure surgery. Am J Ophthalmol. 1987; 104:233–40.
Article
9. McCartney DL, Gottsch JD, Stark WJ. Managing posterior pressure during pseudophakic keratoplasty. Arch Ophthalmol. 1989; 107:1384–6.
Article
10. Inoue Y. Corneal triple procedure. Semin Ophthalmol. 2001; 16:113–8.
Article
11. Kim MK, Lee JH. Long-term outcome of graft rejection after penetrating keratoplasty. J Korean Ophthalmol Soc. 1997; 38:1553–60.
12. Patel SV, Hodge DO, Bourne WM. Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Am J Ophthalmol. 2005; 139:311–9.
Article
13. Bourne WM, O'Fallon WM. Endothelial cell loss during penetrating keratoplasty. Am J Ophthalmol. 1978; 85:760–6.
Article
14. Kramer SG, Stewart HL. Maintenance of the anterior chamber during penetrating keratoplasty. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1976; 81:794–805.
15. Kirkness CM, Ling Y, Moshegov C. Penetrating keratoplasty and raised intraocular pressure. A brief review of the problems and its management. Ann Acad Med Singapore. 1989; 18:168–70.
16. Simmons RB, Stern RA, Teekhasaenee C, Kenyon KR. Elevated intraocular pressure following penetrating keratoplasty. Trans Am Ophthalmol Soc. 1989; 87:79–91. discussion. 91–3.
17. Seitz B, Langenbucher A, Nguyen NX, et al. Long-term follow-up of intraocular pressure after penetrating keratoplasty for keratoconus and Fuchs' dystrophy: comparison of mechanical and Excimer laser trephination. Cornea. 2002; 21:368–73.
18. Nguyen NX, Langenbucher A, Seitz B, et al. Impact of increased intraocular pressure on long-term corneal endothelial cell density after penetrating keratoplasty. Ophthalmologica. 2002; 216:40–4.
Article
19. Burke S, Sugar J, Farber MD. Comparison of the effects of two viscoelastic agents, Healon and Viscoat, on postoperative intraocular pressure after penetrating keratoplasty. Ophthalmic Surg. 1990; 21:821–6.
Article
20. Langenbucher A, Seitz B, Nguyen NX, Naumann GO. Corneal endothelial cell loss after nonmechanical penetrating keratoplasty depends on diagnosis: a regression analysis. Graefes Arch Clin Exp Ophthalmol. 2002; 240:387–92.
Article
21. Gil SY, Park CK, Hahn TW. Evaluation of donor corneal endothelium after keratoplasty. J Korean Ophthalmol Soc. 2006; 47:519–24.
22. Chung SH, Kim HK, Kim MS. Corneal endothelial cell loss after penetrating keratoplasty in relation to preoperative recipient endothelial cell density. Ophthalmologica. 2010; 224:194–8.
Article
23. Sud RN, Loomba R. Achievement of surgically soft and safe eyes–a comparative study. Indian J Ophthalmol. 1991; 39:12–4.
24. Guindon B, Harvey J, Peacocke A, et al. Factors modifying vitreous pressure in cataract surgery. Can J Ophthalmol. 1981; 16:73–5.
25. Shimomura Y, Hosotani H, Kiritoshi A, et al. Core vitrectomy preceding triple corneal procedure in patients at high risk for increased posterior chamber pressure. Jpn J Ophthalmol. 1997; 41:251–4.
Article
26. Konomi K, Shimazaki J, Shimmura S, et al. Efficacy of core vitrectomy preceding triple corneal procedure. Br J Ophthalmol. 2004; 88:1023–5.
Article
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