Deep Anterior Lamellar Keratoplasty After Descemet Stripping Automated Endothelial Keratoplasty

Gutfreund, Shay; Leon, Pia; Graffi, Shmuel; Busin, Massimo

doi:10.1016/j.ajo.2016.12.012

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…There is an increasing trend towards lamellar over full-thickness corneal transplantation, supported by growing evidence from the literature of faster recovery, reduced complications, greater longevity and visual outcomes. The technique we describe, DALK over DSEK, has been performed as a management strategy for eyes with endothelial decompensation, with significant stromal opacities;18 however, in this case series report, we have expanded on the indications for which this staged technique should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…There is paucity in the literature of the incidence of expulsive haemorrhage in PKP for corneal perforation of any aetiology, with the most commonly reported complications of PKP for perforation being graft failure, postkeratoplasty cataract, infection and glaucoma 16 19. However, logical deduction, gaining support from the literature, would suggest that lamellar surgery, compared with ‘open sky’ surgery in PKP, would reduce the risk of expulsive haemorrhage for any indication 4 10 18 20 21…”

Section: Discussionmentioning

confidence: 99%

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Case series of staged lamellar corneal grafting with thin manual Descemet’s stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty

et al. 2022

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The purpose of this report is to present the outcomes of Descemet’s stripping endothelial keratoplasty (DSEK), followed by deep anterior lamellar keratoplasty (DALK), as an alternative to penetrating keratoplasty (PKP) for different indications. Patients in this retrospective case series underwent manual DSEK, followed by manual DALK, for tectonic and/or visual reasons. It includes three cases that underwent DSEK followed by DALK as an alternative to PKP for the following conditions: failed PKP and stromal scarring, aphakic bullous keratopathy and herpetic stromal scarring, and herpetic corneal perforation. All cases had successful anatomical repair with visual improvement. Many corneal conditions involving endothelium and stroma have been traditionally managed with PKP. However, in certain settings with high risk of complications, this might not be an appropriate option. Therefore, for these cases, we propose management with DSEK followed by DALK as an alternative approach in a ‘closed anterior chamber’ fashion, which can reduce the risk of significant, sometimes irreversible, complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case series of staged lamellar corneal grafting with thin manual Descemet’s stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty

et al. 2022

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“…Regardless of the disease severity or the presence of scarring and/or neovascularization, it is reasonable to attempt DALK than to have never given each patient with isolated anterior corneal pathology a fair chance to receive the better surgical option. In challenging cases including inflammatory corneal disease, herpetic keratitis,[ 37 ] intracorneal ring segments,[ 38 ] previous radial keratotomy,[ 39 ] anterior lamellar keratoplasty,[ 40 41 ] and even previous Descemet stripping automated endothelial keratoplasty (DSAEK) surgery,[ 42 43 ] large-diameter DALK can be performed to maximize the refractive benefit of a large-diameter graft while minimizing the risk of endothelial failure. In post-PK eyes with recurrence of stromal disease, large-diameter DALK can be performed through stromal peeling along a natural plane of separation.…”

Section: Standardizing the Technique For Large-diameter Deep Anterior...mentioning

confidence: 99%

Large-diameter deep anterior lamellar keratoplasty: A narrative review

Yu,

Sollazzo,

Bovone

et al. 2024

Taiwan Journal of Ophthalmology

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Deep anterior lamellar keratoplasty (DALK) involves the selective replacement of diseased corneal stroma while preserving healthy unaffected endothelium. While DALK has failed to gain widespread popularity, improved visual and refractive outcomes of large-diameter grafts, which patients directly perceive following suture removal, may represent a compelling reason to shift toward DALK. Since the unaffected host endothelium is retained, DALK offers the opportunity to use large-diameter grafts, which reliably achieves maximum visual potential without an increased risk of immune-mediated stromal rejection. In this narrative review, we evaluate the current evidence on large-diameter DALK including surgical technique and clinical outcomes.

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“…23,24 Moreover, the DALK technique can also be adapted for challenging cases with intracorneal ring segments, 25 previous radial keratotomy, 26 anterior lamellar keratoplasty, 27 and even previous DSAEK surgery. 28,29 In post-PK eyes, stromal exchange can be accomplished through stromal peeling along a natural plane of separation. 30,31…”

Section: Standardizing the Deep Anterior Lamel-lar Keratoplasty Techn...mentioning

confidence: 99%

Deep Anterior Lamellar Keratoplasty: Current Status and Future Directions

Spena

Pellegrini

et al. 2021

Cornea

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Deep anterior lamellar keratoplasty (DALK) involves selective replacement of diseased corneal stroma while preserving normal healthy endothelium. Despite several well-recognized advantages, the uptake of DALK has remained sluggish with an adoption rate that has plateaued over the past decade. Misconceptions such as the rarity of complications of penetrating keratoplasty, lack of standardization of the DALK technique, and limited substantial benefit in visual and refractive outcomes are frequently cited as arguments against performing DALK. This brief review discusses the recent findings that refute these perceived barriers; describes contemporary techniques, tools, and modifications in the surgical approach; and evaluates the evidence regarding the clinical outcomes of DALK.

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Deep Anterior Lamellar Keratoplasty After Descemet Stripping Automated Endothelial Keratoplasty

Cited by 11 publications

References 23 publications

Case series of staged lamellar corneal grafting with thin manual Descemet’s stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty

Case series of staged lamellar corneal grafting with thin manual Descemet’s stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty

Large-diameter deep anterior lamellar keratoplasty: A narrative review

Deep Anterior Lamellar Keratoplasty: Current Status and Future Directions

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