Triple procedure / Corneal transplant with cataract surgery - A State of Sight #106

A full-thickness corneal transplant combined with cataract removal and lens placement is a triple procedure. This is necessary when both a cataract and a cloudy or irregular cornea are interfering with vision.

Watch this episode of A State of Sight with Isaac Porter, MD to learn more about the triple procedure and how it is performed.

Thanks for the question from Joshua at @APE12A on twitter for the topic for this episode!

Welcome to A State of Sight, I’m Isaac Porter and this is your update in ophthalmology and eye care from Raleigh. Today we have a special episode because we are going to explain the triple procedure, which is a corneal transplant along with cataract removal and intraocular lens placement.
Recently, we had a question from Joshua @APE12A about this procedure because soon he is planning to have a triple procedure on one of his eyes. He had a corneal transplant about 17 years ago and now needs to have that transplant replaced. 17 years is a pretty good lifespan for a corneal graft. In the best case situations like keratoconus we may expect a corneal graft to last 15 to 20 years on average which is why many patients need a repeat graft during their lifetime.
Because of this, we like to wait until the graft is absolutely necessary before we perform corneal transplantation. His case is a little bit different, since Joshua is going to have the exchange of a corneal graft with the placement of a new one, and at the same time, a cataract will be removed and a clear artificial lens will be implanted.
With this triple procedure, we can remove the cataract differently than we usually do. When we generally remove a cataract, we make a very small incision at the edge of the cornea and then use ultrasound energy (phacoemulsification) with suction to break up the cataract and remove it from the eye. When we are doing cataract surgery with a triple procedure, we have a large area to access the cataract since we are doing a corneal transplant at the same time.
First, the center of the cornea is removed, then we can open up the lens capsule to expose the cataract. Next, we can remove the cataract manually in one, large piece instead of having to break it up into small pieces. After this, we will put in a lens implant. Often, we like to use a more rigid implant or a different type off lens that may be a little bit larger than usual.
This lens implant (IOL) replaces the cloudy lens that has been removed (the cataract). The IOL is needed for patients to see better, otherwise they would need very thick glasses. The lens implant is placed through the large opening in the center of the cornea. Afterwards, we continue with the corneal transplant and put the new donor cornea tissue into place by suturing it around the central opening.
This method of cataract removal and lens placement is only available when we are doing a full thickness corneal transplant (penetrating keratoplasty). With other types of corneal transplantation like DSEK (Descemet's stripping endothelial keratoplasty) or DALK (Deep anterior lamellar keratoplasty), we remove the cataract a different way. In these cases, we can use the more standard way because we don’t have access to a large opening as with a full thickness graft.

If you have any questions about the triple procedure please post and we will be happy to answer them. Hope to see you again next time on A State of