Sarnicola E, Sarnicola C, and Sarnicola V. “Deep anterior lamellar keratoplasty: surgical technique, indications, clinical results and complications”
In: ESASO Course series Vol 6 “Cornea”. Series editors: Bandello F, Corcòstegui B. Volume
editor: Guell JL.
Abstract
Deep anterior lamellar keratoplasty (DALK) is currently the procedure of choice to restore transparency and curvature in corneal stromal diseases with a healthy endothelium. Preserving the endothelium avoids endothelial rejection and provides a good and stable endothelial cell count, allowing good long-term graft survival. Several surgical techniques have been proposed over the last years, the most common of which include layer-by-layer manual dissection, hydrodissection, viscodissection, big bubble (needle or cannula) and air-viscobubble. Descemet’s membrane rupture represents the most common complication, even in expert hands. The penetrating keratoplasty conversion rate gradually decreases as surgeons become more experienced and learn to manage Descemet’s membrane ruptures. Being able to repair the ruptures would increase the success of DALK and allow patients to benefit from all of its advantages.
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