Introduction:

Deep Anterior Lamellar Keratoplasty (DALK) is an advanced surgical procedure performed to treat corneal diseases that affect the anterior layers while preserving the patient's own endothelium and Descemet's membrane. Unlike traditional penetrating keratoplasty (PKP), which involves replacing the entire cornea, DALK selectively replaces the affected layers, offering better visual outcomes and reducing the risk of graft rejection. This comprehensive article aims to provide valuable insights into DALK, its indications, surgical techniques, recovery, and potential complications, to help patients and eye care professionals understand the benefits and considerations of this precise corneal surgery.

Indications for DALK:

DALK is commonly indicated for the treatment of corneal conditions that predominantly affect the anterior layers while sparing the endothelium, such as:

• Keratoconus: A progressive corneal thinning and steepening that leads to visual distortion.
• Stromal scars: Corneal scarring due to injury, infections, or previous surgeries.
• Keratoglobus: A rare condition characterized by generalized corneal thinning and protrusion.
• Anterior corneal dystrophies: Inherited corneal disorders that primarily affect the front layers.

Surgical Procedure:

DALK involves the following steps:

• Anesthesia: The patient is administered local or general anesthesia to ensure a pain-free procedure.
• Partial thickness trephination: The surgeon creates a partial-thickness cut on the cornea's surface to remove the anterior layers, leaving the endothelium and Descemet's membrane intact.
• Air or viscoelastic injection: An air bubble or viscoelastic material is introduced into the space between the removed layers and the healthy endothelium, creating a pocket to receive the donor tissue.
• Donor tissue preparation: The donor corneal tissue, obtained from an eye bank, is carefully dissected to match the size and shape of the recipient's corneal pocket.
• Transplantation: The donor tissue is then transplanted into the pocket, and the air bubble or viscoelastic material helps to secure it in place.
• Suture or glue: Depending on the surgeon's preference and the specific case, the graft may be sutured or glued to promote proper healing.

Recovery and Complications:

After DALK surgery, patients can expect:

• Postoperative care: The patient will be prescribed eye drops and medications to promote healing and prevent infection.
• Visual recovery: Vision may gradually improve over several weeks to months as the eye heals.

Potential complications of DALK may include:

• Graft rejection: Although the risk is lower than in PKP, there is still a possibility of graft rejection.
• Infection: Infections at the surgical site can be a rare but serious complication.
• Glaucoma: Increased intraocular pressure may occur following surgery.
• Corneal thinning: In some cases, the cornea may become thinner after DALK, requiring close monitoring.

Conclusion:

Deep Anterior Lamellar Keratoplasty (DALK) is a precise and innovative corneal surgery that selectively replaces the affected anterior layers, preserving the patient's endothelium. This advanced technique is highly effective in treating corneal conditions such as keratoconus and stromal scars, offering improved visual outcomes and reduced graft rejection risk compared to traditional penetrating keratoplasty. Understanding the indications, surgical techniques, recovery, and potential complications of DALK can help patients and eye care professionals make informed decisions for optimal eye health and visual rehabilitation.

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