Kumar, Dhivya AshokJacob, SoosanNaveen, PreethiSivagnanam, SoundariAgarwal, Amar2023-08-252023-08-252023-09Kumar Dhivya Ashok, Jacob Soosan, Naveen Preethi, Sivagnanam Soundari, Agarwal Amar. Phacoemulsification, pinhole pupilloplasty, and pre-Descemet抯 endothelial keratoplasty for keratoconus with Fuchs� endothelial dystrophy. Indian Journal of Ophthalmology. 2023 Sep; 71(9): 3242-32451998-36890301-4738http://imsear.searo.who.int/handle/123456789/225249The comorbidity of keratoconus with Fuchs� 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抯 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.Fuchs� endothelial dystrophyirregular astigmatismkeratoconuspinhole pupilloplastypre?Descemet抯 endothelial keratoplastyJournal ArticleIndiaDepartment of Uvea and Oculoplasty, Dr. Agarwal抯 Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, IndiaCornea and Refractive, Dr. Agarwal抯 Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, IndiaCataract and Neurophthal, Dr. Agarwal抯 Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, IndiaCataract, Cornea and Anterior Segment, Dr. Agarwal抯 Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India