LAUSR

PKP surgery, cataract extraction, and intraocular lens implantation (IOL) (PKP triple). Despite the necessity of PKP in these cases, there are few training opportunities for PKP. Furthermore, it is more demanding for nonexperienced surgeons to master PKP triple surgery. In PKP triple surgery, the management of vitreous pressure is essential.2 Specifically, the elevated vitreous pressure in the open-sky condition makes it difficult to complete CCC, cortex aspiration, and IOL implantation. An incomplete CCC may result in posterior capsule rupture. A longer duration of the open-sky condition may induce expulsive choroidal hemorrhage. There are some approaches that reduce the vitreous pressure such as core vitrectomy2,3 or systemic anesthesia. Tsubota et al4 first introduced the effective use of a contact lens during specific cataract surgery (intracapsular cataract extraction). Thereafter, Kawamoto et al5 introduced the safety of a specially invented SCL during the PKP triple procedure. Despite the stable effect, they did not use it for CCC or IOL implantation. Performing both these procedures in the open-sky condition may be very demanding for nonexperienced surgeons. In our method, special contact lens use was not necessary. We used a silicone hydrogel disposable SCL, and small holes aimed at 2 paracentesis were created using a 1.0-mm biopsy punch (Kai Industries, Seki, Japan), as shown in Figure 1. We performed CCC by paracentesis under the use of an ophthalmic viscosurgical device (HEALON, Santa Ana, CA). In some cases, a one-way system was used, whereas in other cases, a 2-way system was used for cortical removal. IOL implantation was extremely comfortable under the ophthalmic viscosurgical device. In this system, a very stable artificial anterior chamber was created, allowing us to perform a stable PKP triple procedure. In conclusion, we strongly recommend the use of this easy and inexpensive system for corneal surgeons all over the world. It does not require the hands of experienced surgeons or buying an expensive motor trephine.3 Because it is difficult to learn a PKP triple procedure because of the infrequency of the procedure, we have to adopt safer operating systems.