Deep Anterior Lamellar Keratoplasty: A Surgeon's Guide

Overview

Journal J Curr Ophthalmol

Date 2018 Dec 18

PMID 30555961

Citations 18

Authors

Mayank A Nanavaty

Kanwaldeep Singh Vijjan

Camille Yvon

Affiliations

Soon will be listed here.

Abstract

Purpose: To review and highlight important practical aspects of deep anterior lamellar keratoplasty (DALK) surgery and provide some useful tips for surgeons wishing to convert to this procedure from the conventional penetrating keratoplasty (PK) technique.

Methods: In this narrative review, the procedure of DALK is described in detail. Important pre, intra, and postoperative considerations are discussed with illustrative examples for better understanding. A comprehensive literature review was conducted in PubMed/Medline from January 1995 to July 2017 to identify original studies in English language regarding DALK. The primary endpoint of this review was the narrative description of surgical steps for DALK, its pitfalls, and management of common intraoperative complications.

Results: A standard DALK procedure can be successfully performed taking into consideration factors such as age, ophthalmic co-morbidities, status of the crystalline lens, retina, and intraocular pressure. Careful trephination and dissection of the host cornea employing appropriate technique (such as big bubble technique, manual dissection, visco-dissection, etc.) suitable for the specific case is important to achieve good postoperative outcomes. Prompt identification of intraoperative complications such as double bubble, micro and macroperforations, etc. are vital to change the management strategies.

Conclusion: Although there is a steep learning curve for DALK procedure, considering details and having insight into the management of intraoperative issues facilitates learning and reduces complication rates.

Citing Articles

Strategic Management of Descemet's Membrane Perforation During DALK in Advanced Keratoconus.

Gheorghe A, Onofrei A, Arghirescu A, Coleasa A, Tiran G, Dinu L Rom J Ophthalmol. 2025; 68(4):448-456.

PMID: 39936068 PMC: 11809823. DOI: 10.22336/rjo.2024.81.

Bio-orthogonal crosslinking and hyaluronan facilitate transparent healing after treatment of deep corneal injuries with in situ-forming hydrogels.

Chen F, Han U, Wungcharoen T, Seo Y, Le P, Jiang L NPJ Regen Med. 2025; 10(1):8.

PMID: 39905045 PMC: 11794660. DOI: 10.1038/s41536-024-00385-9.

Intraoperative Optical Coherence Tomography (OCT)-Guided Femtosecond Laser-Assisted Descemet Membrane Endothelial Keratoplasty (iFAD).

Lim J, Abusayf M, Liu Y, Mehta J Bioengineering (Basel). 2025; 11(12.

PMID: 39768010 PMC: 11726893. DOI: 10.3390/bioengineering11121192.

Main issues in deep anterior lamellar keratoplasty: A systematic narrative review.

Niazi S, Alio Del Barrio J, Doroodgar F, Javadi M, Alio J Taiwan J Ophthalmol. 2024; 14(1):34-43.

PMID: 38654987 PMC: 11034680. DOI: 10.4103/tjo.TJO-D-23-00175.

Large-diameter deep anterior lamellar keratoplasty: A narrative review.

Yu A, Sollazzo A, Bovone C, Busin M Taiwan J Ophthalmol. 2024; 14(1):27-33.

PMID: 38654986 PMC: 11034690. DOI: 10.4103/tjo.TJO-D-23-00161.

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