Corneal Transplants – Lamellar: DALK, DSAEK, DMEK are new forms of corneal transplantation which promise faster visual recovery with a significantly reduced chance of corneal graft rejection.
The idea of creating a deep lamellar bed for lamellar keratoplasty is not new. Mühlbauer was the first to describe a technique for anterior lamellar keratoplasty (ALK) in 1840. Dr. Duplessie is a pioneer in modern lamellar corneal surgery, Corneal Transplants – Lamellar: DALK, DSAEK
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.
Corneal Transplants – Lamellar: DALK, DSAEK. There are 2 types of lamellar keratoplasty:
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Anterior {ALK, DALK}
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Posterior {DSAEK}
ALK does not include corneal endothelium, so donor tissue is more easily obtained.
Indications include anterior corneal pathology in which the posterior cornea is unaffected.
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.
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.
DALK
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.