• Deep anterior lamellar keratoplasty
• DALK
• penetrating keratoplasty
• PKP
• endothelial keratoplasty
• cornea
• treatment surgery

Deep anterior lamellar keratoplasty (DALK) is finally coming of age as surgeons increasingly gravitate towards disease-specific lamellar keratoplasty procedures in lieu of full thickness penetrating keratoplasty (PKP). In DALK, all or almost all of the central corneal stroma is removed while leaving the recipient endothelium and Descemet membrane (DM) intact, so it is suitable for treating any corneal condition in which the host DM and endothelium remain healthy. While generally considered more difficult to perform than PKP, DALK eliminates problems with postoperative endothelial rejection, preserves endothelial cell density, reduces use of topical corticosteroids with their concomitant complications and allows earlier suture removal. The DM-baring DALK techniques, such as the Anwar big bubble technique,1 provide visual outcomes comparable with or even better than PKP, as confirmed in the case/control study reported by Tan et al (see page 1295).2

Anterior lamellar keratoplasty (ALK) techniques have been used for decades, but early methods were not able to consistently match the visual outcomes obtained with PKP due to variability in the dissection planes in both the donor and recipient corneas.3 4 More recently, techniques designed to facilitate complete or nearly complete removal of host central stroma have provided superior visual outcomes because a full-thickness donor without DM and endothelium is used and has an extremely smooth posterior surface.1 5 6 These deep dissection techniques have been differentiated from earlier ALK methods by the name DALK.

The most obvious advantage …