Purpose: A retrospective study was performed to examine time-related changes in the corneal endothelium in eyes that underwent a triple procedure consisting of penetrating keratoplasty, extracapsular excision, and intraocular lens (IOL) insertion.
Materials and methods: We studied 39 eyes from 36 patients who underwent a triple procedure associated with corneal transplantation at Tokyo Medical University between February 1989 and May 1996. The ages of the patients at the time of operation ranged from 61 to 91 years (mean, 70.9 +/- 10.8 years). The postoperative follow-up period ranged from 13.6 to 107.5 months (mean, 53.4 +/- 27.1 months). The following were evaluated: 1) cure rate of transparency, 2) complications, 3) time-related changes of endothelial cell density during 7 years after operation, and 4) comparison of changes in endothelial cell density associated with various factors such as primary disease, graft, IOL, and rejection.
Result: The following results were obtained. 1. The cure rate of transparency of the graft at the last examination(a mean of 53.4 +/- 27.1 months after surgery) was 82.1%. 2. The incidence of rejection at the last examination was 35.9%. 3. The mean endothelial cell density in the graft was 2945.8 cells/mm2 before operation, and decreased to 1806.7 cells/mm2 one year after operation, and further to 1161.1 cells/mm2 five years after operation, showing a reduction of 60.6% compared to the mean before operation. 4. The annual rate of endothelial cell reduction in the same patient was approximately 25% the first year after operation and gradually lessened from the second year, reaching a stable level of 6% after the third year. 5. The punching method(done from the epithelial side), diameter of optical zone of IOL (6 mm or less), and rejection contributed to the reduction of endothelial cell density by one year after the operation.
Conclusion: The triple procedure is considered to be a technique that may be chosen actively.