Precision Pulse Capsulotomy During Combined Penetrating Keratoplasty With Cataract Surgery and Intraocular Lens in Small Nondilating Pupil

OBJECTIVE: To demonstrate precision pulse capsulotomy (PPC) in an open-sky procedure and to evaluate its use during triple procedure keratoplasty in small nondilating pupils. METHODS: This single-center retrospective case series study included 10 eyes (from 10 patients) with corneal opacity and poorly dilated pupils who were scheduled to undergo triple procedure keratoplasty. The main outcome measures were capsulotomy performance of the PPC device and intraoperative complications. Secondary outcome measures included postoperative best-corrected visual acuity, intraocular pressure, and other postoperative complications. RESULTS: Complete free-floating capsulotomy was achieved in all 10 eyes. There were no cases of anterior capsule tears or tags. There were no postoperative complications that occurred in association with the PPC device. CONCLUSIONS: The PPC device facilitates creation of a smooth, round, and appropriately sized anterior capsulotomy in open-sky surgeries, particularly in presence of small nondilating pupils.