Fig. 1

Design of combined penetrating keratoplasty (PKP), pars plana vitrectomy (PPV), and intraocular lens (IOL)-suture surgery a The surgical design should be determined prior to surgery including where to place the scleral ring and whether to create two scleral flaps or three-ports. After determination of the surgical design, two scleral pockets for the intraocular lens (IOL) suturing are created at the surgeons’ preference. b A scleral ring (Nishida ring, Inami) is sutured to the sclera with 6–0 silk. c Two 10–0 polypropylene sutures (PC-9) are fixated to the top of the IOL loop (CZ, Alcon) before the next procedure. d Three-ports are created using a 25-gauge trocar (Alcon), and the infusion canula was set. e Using the wide-viewing system, core vitrectomy and peripheral vitrectomy is performed. f, g Using a trephine and Katzin Scissors, the host cornea is removed. h In the open-sky technique (partial dissection), the IOL is sutured to the two scleral flaps 1.5 mm from the limbus. i The IOL is placed at the back of the iris and is centred. j The donor graft is sutured using 10–0 nylon