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Deep anterior lamellar keratoplasty using an original manual technique
  1. Paolo Rama,
  2. Karl Anders Knutsson,
  3. Giulia Razzoli,
  4. Stanislav Matuska,
  5. Maurizia Viganò,
  6. Giorgio Paganoni
  1. Department of Ophthalmology, Cornea and Ocular Surface Disease, San Raffaele Scientific Institute, Milan, Italy
  1. Correspondence to Dr Paolo Rama, Ospedale San Raffaele, Unità Cornea e Superficie Oculare, Via Olgettina 60, Milano 20132, Italy; rama.paolo{at}


Aims To evaluate the clinical findings and visual outcomes of deep anterior lamellar keratoplasty (DALK) using an original manual dissection technique.

Methods 288 eyes (268 patients) with corneal pathologies without endothelial involvement were treated by DALK using an original manual dissection technique guided by a calibrated knife incision based on ultrasonic pachimetry values. Clinical records were examined retrospectively at 2 months, 6 months, 1 year and 2 years. The following outcomes were measured: visual acuity, topographic parameters, endothelial cell density and recipient stromal residue thickness.

Results At the 2-year postoperative follow-up, the mean logarithm of the minimum angle of resolution best spectacle corrected visual acuity (BSCVA) was 0.131±0.087 and topographic astigmatism was 2.87±1.57 diopters. In 12 cases (4.2%) a perforation of Descemet's membrane required conversion of the procedure to penetrating keratoplasty. Mean optical coherence tomography (OCT) residue thickness (measured in 82 eyes with OCT Visante) was 31.63±24.57 μm; lower values of recipient residue thickness were significantly associated with higher BSCVA (Spearman coefficient 0.635, p< 0.001).

Conclusion DALK using a dry manual dissection technique provides visual, refractive and clinical results comparable to other deep lamellar techniques. Eyes with lower values of recipient residue thickness are associated with better visual acuity.

  • Cornea
  • corneal transplactation
  • deep anterior lamellar keratoplasty
  • keratoplasty
  • lamellar keratoplasty

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by San Raffaele Hospital Ethics Committee, Milan, Italy.

  • Provenance and peer review Not commissioned; externally peer reviewed.