Closed-system phacoemulsification and posterior chamber implant combined with penetrating keratoplasty.

The main intraoperative difficulties of performing a procedure combining open-sky extracapsular cataract extraction, implantation of posterior chamber intraocular lens (PC-IOL), and penetrating keratoplasty ("triple procedure"), most frequently caused by the uncompensated posterior pressure created when the cornea is open, include incomplete capsulorhexis, incomplete aspiration-irrigation of the cortex, uncertain placing of the IOL, posterior capsule rupture, choroidal effusion, and even expulsive hemorrhage. We recommend a two-step procedure that eliminates these problems: The first step begins with removal of epithelium, half-thickness trephining of the cornea, and capsulorhexis; proceeds through phacoemulsification and aspiration-irrigation; and ends with implantation of the PC-IOL, using a pressurized system. The second step is penetrating keratoplasty.

Retinal break type and proliferative vitreoretinopathy in nontraumatic retinal detachment.

In a retrospective study of 1180 consecutive eyes operated for retinal detachment, vitreous traction on the rent was the determining factor for the development of proliferative vitreoretinopathy (PVR). Round, multiple, small holes in equatorial degeneration (retinogenic) and macular holes in which no vitreous traction on the rent was found did not complicate with PVR. Retinal detachment caused by horseshoe or crescent-shaped tears with evidence of vitreous traction (vitreogenic) developed PVR to a variable degree: in 171 (25.