Br J Ophthalmol 1999;83:458-462 ( April )
The triple procedure: in the bag placement versus ciliary sulcus
placement of the intraocular lens
Vincent M Borderie,a
Olivier Touzeau,a
Tristan Bourcier,a
Santos Carvajal-Gonzalez,b
Laurent Larochea
a Department of
Ophthalmology, Hôpital Saint Antoine, Assistance Publique-Hôpitaux
de Paris, Paris, France, b INSERM
Unité 339, Hôpital Saint Antoine, Paris, France
Correspondence to: Vincent M Borderie, MD, Service d'Ophtalmologie, Hôpital Saint
Antoine, 184 rue du Fg St-Antoine, 75571 Paris Cedex 12, France.
Accepted for publication 10 November 1998
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.
METHODS40 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.
RESULTSOut 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.
CONCLUSIONIn 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
© 1999 by British Journal of Ophthalmology
