{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:42:57Z","timestamp":1786653777687,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>The comorbidity of keratoconus with Fuchs\u2019 endothelial dystrophy with cataract is a rare clinical combination. We present an amalgamation of surgical techniques to manage the above clinical conditions and its complications in single setting. The modified triple procedure, namely, the phacoemulsification, pinhole pupilloplasty, and pre-Descemet\u2019s endothelial keratoplasty (PDEK) in the order of description is followed in single sitting. Lens removal by phacoemulsification, correction of irregular astigmatism by pinhole pupilloplasty (pinhole optics), and exchanging the endothelial layer for PDEK forms the main segments of the triple procedure. This combination of techniques may decrease the risk of multiple surgeries and its related complications. Moreover, it will allow the patient for faster visual rehabilitation by improving the uncorrected visual acuity and visual quality.<\/jats:p>","DOI":"10.4103\/ijo.ijo_3023_22","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T06:40:40Z","timestamp":1692600040000},"page":"3242-3245","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Phacoemulsification, pinhole pupilloplasty, and pre-Descemet\u2019s endothelial keratoplasty for keratoconus with Fuchs\u2019 endothelial dystrophy"],"prefix":"10.4103","volume":"71","author":[{"given":"Dhivya Ashok","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Uvea and Oculoplasty, Dr. Agarwal\u2019s Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soosan","family":"Jacob","sequence":"additional","affiliation":[{"name":"Cornea and Refractive, Dr. Agarwal\u2019s Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preethi","family":"Naveen","sequence":"additional","affiliation":[{"name":"Cornea and Refractive, Dr. Agarwal\u2019s Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soundari","family":"Sivagnanam","sequence":"additional","affiliation":[{"name":"Cataract and Neurophthal, Dr. Agarwal\u2019s Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Cataract, Cornea and Anterior Segment, Dr. Agarwal\u2019s Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"R1-20251008","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/00003226-199010000-00006","article-title":"Keratoconus associated with corneal endothelial dystrophy","volume":"9","author":"Orlin","year":"1990","journal-title":"Cornea"},{"key":"R2-20251008","first-page":"1253","article-title":"Phacoemulsification in a rare case of keratoconus with Fuchs'endothelial corneal dystrophy","volume":"8","author":"Kaushik","year":"2015","journal-title":"Int J Ophthalmol"},{"key":"R3-20251008","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1097\/ICO.0000000000001391","article-title":"Single-pass 4-throw pupilloplasty for pre-Descemet endothelial keratoplasty","volume":"36","author":"Narang","year":"2017","journal-title":"Cornea"},{"key":"R4-20251008","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1016\/j.ophtha.2006.06.036","article-title":"Potential complications of ocular surgery in patients with coexistent keratoconus and Fuchs endothelial dystrophy","volume":"113","author":"Jurkunas","year":"2006","journal-title":"Ophthalmology"},{"key":"R5-20251008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ICO.0b013e3182a7389c","article-title":"Descemet stripping endothelial keratoplasty for the treatment of combined Fuchs corneal endothelial dystrophy and keratoconus","volume":"33","author":"Vira","year":"2014","journal-title":"Cornea"},{"key":"R6-20251008","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1016\/j.ophtha.2005.04.022","article-title":"Higher-order aberrations in eyes with irregular corneas after laser refractive surgery","volume":"112","author":"McCormick","year":"2005","journal-title":"Ophthalmology"},{"key":"R7-20251008","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/j.jcrs.2017.09.014","article-title":"New pinhole sulcus implant for the correction of irregular corneal astigmatism","volume":"43","author":"Trindade","year":"2017","journal-title":"J Cataract Refract Surg"},{"key":"R8-20251008","doi-asserted-by":"crossref","first-page":"e228902","DOI":"10.1136\/bcr-2018-228902","article-title":"Xtra focus pinhole IOL (Morchers GMBH) a novel approach to tackle irregular astigmatism and large pupillary defects with a single step surgery","volume":"12","author":"Agarwal","year":"2019","journal-title":"BMJ Case Rep"},{"key":"R9-20251008","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.jcrs.2017.07.027","article-title":"Single-pass four-throw pupilloplasty: Postoperative mydriasis and fundus visibility in pseudophakic eyes","volume":"43","author":"Kumar","year":"2017","journal-title":"J Cataract Refract Surg"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_3023_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:42:17Z","timestamp":1786650137000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_3023_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,21]]},"references-count":9,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_3023_22","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,21]]},"assertion":[{"value":"2022-11-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}