Lamellar: DALK, DSAEK, DMEK are new forms of corneal transplantation which promise faster visual recovery with a significantly reduced chance of corneal graft rejection. Reducing healing times from one year to effective vision at 2 weeks. Dr. Duplessie was one of the few surgeons in the United States experienced enough to write the first textbook chapter on modern lamellar corneal transplantation.
Front of the eye
Partial thickness cornea scars of the cornea can be repaired with removing the entire cornea.
Less surgery means faster healing. A normal corneal transplant heals in a year. We expect effective vision in this transplant in two weeks.
The endothelial cells on the inside of the cornea pump fluid out to keep the cornea clear. Certain diseases can cause them to fail early.
The endothelial cells are the same thickness as a red blood cell. They are extra-ordinarily delicate, and should not be touched.
ALK does not include corneal endothelium, so donor tissue is more easily obtained.
DALK
Does not include corneal endothelium, so donor tissue is more easily obtained.
The indications for the use of anterior lamellar surgery has changed as the technology of the instrumentation has improved, and include keratoconus, laser in situ keratomileusis (LASIK)-induced kerectasia, corneal alkali burns, Terrien’s marginal degeneration, anterior corneal dystrophies and corneoconjunctival malignant melanoma.
Indications include anterior corneal pathology in which the posterior cornea is unaffected.
Lamellar corneal surgery offers faster healing time and less risk of corneal graft rejection versus penetrating keratoplasty (PKP) which had been the gold standard treatment for corneal transplantation.
Lamellar surgery technically quite difficult. The posterior surface of the cornea is invisible to the eye when using the operating microscope.
Advances in surgical equipment and new techniques have refined lamellar corneal surgery. Surgery time has been reduced and safety has improved. The “Big Bubble” technique has been replaced with an all laser procedure.
Recent advances in surgical equipment and technique have redefined lamellar corneal surgery. Viscosurgical, microkeratome, and laser advances have improved the ability to expose Descemet’s membrane, and have dramatically reduced surgery time, while improving the safety of the procedure.