We describe a surgical technique combining penetrating keratoplasty and cataract surgery with a secure anterior chamber to manage coexisting corneal opacity and cataract. Lamellar corneal dissection is performed to 80% of the corneal depth to provide sufficient visibility for cataract surgery. Manual small-incision cataract extraction and intraocular lens implantation is performed through a frown-shaped scleral tunnel. Subsequently, 4 small penetrating incisions are made along the edge of the trephination mark at the 3, 6, 9, and 12 o'clock positions. A graft is placed on the ophthalmic viscosurgical device-coated stromal bed, and the 4 penetration sites are sutured. The stromal bed is cut along the trephination groove, the graft is sutured quadrant by quadrant, and the stromal bed is drawn out of the anterior chamber. The surgery is completed with 16 sutures.
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