The Triple Procedure—Is It the Best Approach for the Patient? Sequential Surgery May Be the Best Approach for the Patient

The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion

“…[3][4][5]9,10,13,[15][16][17][18][19][20][21][22]24,32,36 Supporters of sequential surgery highlight the potential for large ametropic errors with triple procedure surgery, arguing that IOL power can be calculated with greater accuracy when biometry is performed on a stable graft. 26,34 Sixty-seven percent of eyes that underwent sequential surgery in our study were within ±2 D of emmetropia at 1 year. Only 50% of eyes recorded this at the second year, but this may have been influenced by the low numbers of eyes with complete follow-up data.…”

“…Whether to perform a triple procedure or sequential surgery remains a debated topic. 25,26 Small comparative studies have reported superior visual and refractive outcomes with sequential surgery owing to better IOL power calculation from stable post-PK keratometry readings. [26][27][28][29][30] Our aim was to compare triple procedure and sequential surgery, in terms of visual and refractive outcomes at 1 and 2 years after PK, using data collected routinely through the UK Transplant (UKT).…”

The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion

“…[3][4][5]9,10,13,[15][16][17][18][19][20][21][22]24,32,36 Supporters of sequential surgery highlight the potential for large ametropic errors with triple procedure surgery, arguing that IOL power can be calculated with greater accuracy when biometry is performed on a stable graft. 26,34 Sixty-seven percent of eyes that underwent sequential surgery in our study were within ±2 D of emmetropia at 1 year. Only 50% of eyes recorded this at the second year, but this may have been influenced by the low numbers of eyes with complete follow-up data.…”

“…Whether to perform a triple procedure or sequential surgery remains a debated topic. 25,26 Small comparative studies have reported superior visual and refractive outcomes with sequential surgery owing to better IOL power calculation from stable post-PK keratometry readings. [26][27][28][29][30] Our aim was to compare triple procedure and sequential surgery, in terms of visual and refractive outcomes at 1 and 2 years after PK, using data collected routinely through the UK Transplant (UKT).…”

Sequential Versus Combined Penetrating Keratoplasty and Cataract Surgery

“…Sequential surgery, allows measurement of postkeratoplasty keratometry or topography for use in the calculation of the power of the intraocular lens as well as the modification of the postkeratoplasty refractive error at the time of cataract surgery. 2 Although there have been studies supporting or advocating either triple procedure [3][4][5][6] or sequential surgery, 2,7,8 it remains unclear which type of surgery optimizes the refractive and visual outcome. In particular, many of these studies 2,[3][4][5][6][7] have relied on the use of spherical equivalents to assess outcome, which is relatively insensitive and may underestimate or not detect differences in refractive outcome between procedures.…”

Refractive surgery after corneal transplantation

“…Some advocate an initial triple procedure (combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation) [29], whereas others recommend initial penetrating keratoplasty followed by later cataract extraction and intraocular lens implantation [30,31]. In the latter case, the function of cataract surgery is frequently refractive.…”

The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion

“…[3][4][5]9,10,13,[15][16][17][18][19][20][21][22]24,32,36 Supporters of sequential surgery highlight the potential for large ametropic errors with triple procedure surgery, arguing that IOL power can be calculated with greater accuracy when biometry is performed on a stable graft. 26,34 Sixty-seven percent of eyes that underwent sequential surgery in our study were within ±2 D of emmetropia at 1 year. Only 50% of eyes recorded this at the second year, but this may have been influenced by the low numbers of eyes with complete follow-up data.…”

“…Whether to perform a triple procedure or sequential surgery remains a debated topic. 25,26 Small comparative studies have reported superior visual and refractive outcomes with sequential surgery owing to better IOL power calculation from stable post-PK keratometry readings. [26][27][28][29][30] Our aim was to compare triple procedure and sequential surgery, in terms of visual and refractive outcomes at 1 and 2 years after PK, using data collected routinely through the UK Transplant (UKT).…”

Sequential Versus Combined Penetrating Keratoplasty and Cataract Surgery

“…Sequential surgery, allows measurement of postkeratoplasty keratometry or topography for use in the calculation of the power of the intraocular lens as well as the modification of the postkeratoplasty refractive error at the time of cataract surgery. 2 Although there have been studies supporting or advocating either triple procedure [3][4][5][6] or sequential surgery, 2,7,8 it remains unclear which type of surgery optimizes the refractive and visual outcome. In particular, many of these studies 2,[3][4][5][6][7] have relied on the use of spherical equivalents to assess outcome, which is relatively insensitive and may underestimate or not detect differences in refractive outcome between procedures.…”

Refractive surgery after corneal transplantation

“…Some advocate an initial triple procedure (combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation) [29], whereas others recommend initial penetrating keratoplasty followed by later cataract extraction and intraocular lens implantation [30,31]. In the latter case, the function of cataract surgery is frequently refractive.…”

The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion

“…[3][4][5]9,10,13,[15][16][17][18][19][20][21][22]24,32,36 Supporters of sequential surgery highlight the potential for large ametropic errors with triple procedure surgery, arguing that IOL power can be calculated with greater accuracy when biometry is performed on a stable graft. 26,34 Sixty-seven percent of eyes that underwent sequential surgery in our study were within ±2 D of emmetropia at 1 year. Only 50% of eyes recorded this at the second year, but this may have been influenced by the low numbers of eyes with complete follow-up data.…”

“…Whether to perform a triple procedure or sequential surgery remains a debated topic. 25,26 Small comparative studies have reported superior visual and refractive outcomes with sequential surgery owing to better IOL power calculation from stable post-PK keratometry readings. [26][27][28][29][30] Our aim was to compare triple procedure and sequential surgery, in terms of visual and refractive outcomes at 1 and 2 years after PK, using data collected routinely through the UK Transplant (UKT).…”

Sequential Versus Combined Penetrating Keratoplasty and Cataract Surgery

“…Sequential surgery, allows measurement of postkeratoplasty keratometry or topography for use in the calculation of the power of the intraocular lens as well as the modification of the postkeratoplasty refractive error at the time of cataract surgery. 2 Although there have been studies supporting or advocating either triple procedure [3][4][5][6] or sequential surgery, 2,7,8 it remains unclear which type of surgery optimizes the refractive and visual outcome. In particular, many of these studies 2,[3][4][5][6][7] have relied on the use of spherical equivalents to assess outcome, which is relatively insensitive and may underestimate or not detect differences in refractive outcome between procedures.…”

Refractive surgery after corneal transplantation

“…Some advocate an initial triple procedure (combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation) [29], whereas others recommend initial penetrating keratoplasty followed by later cataract extraction and intraocular lens implantation [30,31]. In the latter case, the function of cataract surgery is frequently refractive.…”