Deep anterior lamellar keratoplasty (DALK) is performed in Indianapolis at Price Vision Group when the scarring or corneal disease involves the front half of the cornea. The anterior portion of the cornea is removed, leaving the very thin posterior portion of the cornea and the new donor cornea is then sutured into place.
The advantages of an DALK over the traditional full thickness graft are the rejection of corneal tissue occurs in the posterior part of the cornea, so by leaving the patient’s posterior cornea in place we can greatly reduce the likelihood of corneal graft rejection. Because there is less likelihood of rejection, the anti rejection medications can be discontinued in about 6 weeks vs. 4 to 6 months for a full-thickness graft. The anti-rejection medications can cause glaucoma and cataracts to develop in some patients, so shortening the time a patient uses these medication will lessen the chances for these side effects to occur.
The anti-rejection medications can also slow the wound healing time. Because the anti-rejections medications are used only a short time with the anterior lamellar grafts, the wound heals more rapidly and the sutures can typically be removed in about 6 to 9 months vs. 12 months or more for a full thickness transplant.
The eye is also stronger after an anterior lamellar graft compared to a full thickness graft. We are able to make that wound even stronger for both a full thickness graft and an anterior lamellar graft if the tissue is cut with a laser. The donor tissue and your corneal tissue can be exactly matched so they fit together like lock and key. The cut can be made in a zigzag vs. just the straight up and down in order to allow more surface area for healing. This provides a stronger wound postoperatively.
At the time of surgery the thin posterior membrane can rupture and in that case the surgery is converted to a full thickness transplant (PKP).