Deep anterior lamellar Keratoplasty

Abstract

Keratoconus is a disease causing increased steepening of the cornea resulted in irregular astigmatism. Treatment options are Glasses, Hard contact lenses, Cross linking, Intracorneal Segments insertion, Refractive surgery (Gilda et al., 2008), or Keratoplasty. Lamellar Keratoplasty (LKP) can be a better choice to manage cases of moderate and some cases of severe Keratoconus without deep scarring and severe thinning, also in cases of corneal scarring not involving the deeper layers of the cornea. LKP is a corneal graft technique consisting of transplantation of partial-thickness donor tissue, devoid of endothelium, Descemet membrane (DM), and rear stroma into a recipient healthy stromal bed after dissection of pathologic anterior stroma. However, deep lamellar Keratoplasty (DLKP) is a surgical method that completely removes pathologic corneal stroma tissue down to the DM, followed by transplantation of donor cornea without endothelium over the host bed. DLKP has a number of advantages over penetrating Keratoplasty (PKP). Because it does not violate the intraocular structures of the eye, it diminishes or eliminates the chance of postoperative glaucoma, cataract formation, retinal detachment, cystoids macular edema, expulsive choroidal hemorrhage and epithelial ingrowths. Furthermore, this procedure avoids the replacement of host endothelium with donor endothelium and thus precludes endothelial graft rejection, with comparable visual outcomes and low rate of chronic endothelial cell loss compared to PKP.

Femtosecond laser-assisted corneal transplantation

“…[ 14 , 15 ] It provides a precise and reproducible plane of dissection at the desired depth in corneal stroma. [ 16 ] These may lead to faster and better visual rehabilitation. However, the FSL cannot penetrate opaque tissue, and deep lamellar cutting may result in irregular surfaces due to poor penetration.…”

Stabilization Period of Central Corneal Thickness, Anterior Chamber Depth and Iridocorneal Angle Parameters After Deep Anterior Lamellar Keratoplasty in Keratoconus Patients

“…The donor cornea is transplanted leaving the endothelium and the Descemet's membrane (DM) intact, which reduces the incidence of peroperative and postoperative complications and graft rejection (4). DALK is now preferred to penetrating keratoplasty (PK) in patients with a healthy endothelium (4,5).…”

Graft survival rate of deep anterior lamellar keratoplasty for keratoconus

“…Penetrating keratoplasty (PKP) has been used to treated progressive stage keratoplasty for several decades. [ 14 – 16 ] However, in recent years, deep anterior lamellar keratoplasty (DALK) [ 17 , 18 ] has been increasingly chosen by patients instead of PKP owing to minimal violation of the intraocular structures and reduced adverse effects of the former. DALK can effectively decrease the failure rates of grafts by retaining patients’ corneal endothelium and reducing immunological rejection post-transplantation.…”