Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK)-combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications. Design: Nonrandomized prospective noncomparative interventional case series. Participants: Sixty-five patients who underwent triple procedures between June 2001 and September 2003. Methods: Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination, anterior vitreous tappingwas performedwith a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. Main Outcome Measures: Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous, intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 months. Results: Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6±2.6months (range,6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8%had a postoperative BCVA of ≥20/160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed. Conclusions: Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications. Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK) -combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications. Nonrandomized prospective noncomparative interventional case series. Participants: Sixty-five patients who underwent triple procedures between June 2001 and September 2003. Methods: Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination , anterior vitreous tapping was performed with a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. Main Outcome Measures: Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous , intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 m Results: Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6 ± 2.6months (range, 6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8% had a postoperative BCVA of ≥20 / 160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed. Conclusions: Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications.