What is Deep anterior lamellar keratoplasty?
The Deep anterior lamellar keratoplasty (DALK) technique involves replacing the two outer layers of the affected cornea and substituting these with a healthy corneal button of partial thickness.
Benefits of deep anterior lamellar keratoplasty
- Improved vision. Approximately 75% of transplant patients have enough vision to drive, although they often need glasses or contact lenses, and, in some cases, further surgery to improve the quality of their eyesight.
Risks with deep anterior lamellar keratoplasty
- Rare but serious complications
- Infections that can affect the eyesight (1 in 1,000).
- Severe bleeding that causes loss of vision.
- Retinal detachment.
- Severe inflammation or other causes of vision loss.
- Cornea transplant rejection. One in six patients may reject the transplant at some time in the first two years after surgery. This often occurs because the patient stops taking the anti-rejection treatment without advice from their doctor. However, rejection remains a possibility throughout the patient's life.
- Conversion to penetrating keratoplasty. In 10% of patients it is not possible to perform a partial thickness transplant, like DALK, so it is necessary to carry out a keratoplasty of the entire cornea, or penetrating keratoplasty.
Advantages of Deep anterior lamellar keratoplasty (DALK) over penetrating keratoplasty
- As DALK is an extraocular technique, there is less risk of serious complications, such as infection and bleeding.
- Less risk of transplant rejection.
- The corneal wound after DALK is not as severe as after penetrating keratoplasty, because the stitches are placed in the outermost part and are removed earlier.
Surgery: deep anterior lamellar keratoplasty (DALK)
Generally, the operation is performed under local anaesthetic and lasts approximately an hour. An 8 mm partial section of the damaged cornea is removed and substituted with a similar button from a healthy donor. The patient's healthy tissue behind the transplant is preserved. It is sutured with simple stitches that are neither visible nor noticeable. After the operation, the extracted cornea is examined under a microscope in the microbiology and/or pathology lab.
The patient is discharged the same day. The surgeon follows up on the procedure the next day, and then on a weekly basis. From that point, the patient must have regular check-ups. If they work, it is advised that they take a two-week sick leave.
Post-transplant care
After the operation, the patient has to use anti-rejection eye drops for at least a year and, in some cases, forever. The stitches can be removed starting three to six months after the operation.
Substantiated information by:
Published: 27 November 2019
Updated: 27 November 2019
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