Deep anterior Lamellar keratoplasty

It refers to corneal transplant where the outer/front part of the cornea is replaced. It is performed when the posterior part of the cornea, the “endothelium” is healthy and the disease is confined to the front layers of the cornea. It is usually performed in keratoconus.

The advantages compared with full thickness transplant are that the there is less risk of rejection and longer graft survival and the eye wall is stronger. The recovery process is similar to penetrating keratoplasty but the stitches can come out sooner and hence recovery of vision can be faster. The operation is performed under general or local anaesthetic and takes about one hour. A central 8mm button of the patient’s cornea is removed and a similar-sized button of the donor cornea is sewn in with tiny stitches.  These cannot be felt nor seen. Patients can go home after the operation the same day.

Anterior Lamellar Keratoplasty, only the outer layer of the cornea are transplanted because diseased (for instance in keratoconus)

Deep anterior Lamellar keratoplasty (DALK)

Usual follow-up after surgery takes place at day one, week one and thereafter month 3,6 and 12. We generally recommend that you take 2 weeks off work. You will need to use steroid anti-rejection eye drops for at least 6 months and in some cases longer. Stitches are usually removed after 8 months for surgery. The vision is variable during this period and only the stitched are fully removed the final visual outcome can be realized. Patients are assessed for glasses or contact lenses and in some cases can undergo further procedures including laser eye surgery and implantable contact lens surgery to further ameliorate the outcome.