DALK Corneal Transplant Surgery

A DALK Corneal Transplant, or deep anterior lamellar keratoplasty, is a surgical technique in which most of the cornea is replaced while preserving the thin posterior membrane of the eye known as the Descemet membrane and endothelium.

It is an alternative to full thickness Penetrating Keratoplasty (PKP) and is indicated for the management of advanced keratoconus, corneal scarring, post LASIK ectasia, and endothelium spearing corneal dystrophies and degenerations. DALK tends to be more complex and difficult to perform when compared to other corneal operations since the surgeon is trying to preserve the innermost layer. If the Descemet membrane is perforated during the operation, the surgeon must convert to a full corneal transplant or penetrating keratoplasty.

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DALK Surgery Procedure

Before your surgery, the surgeon will meet with you in our office and examine you before deciding on surgery as the ultimate treatment option. Testing and measurements will be performed at the time of your appointment. Any questions will be answered and the informed consent (giving permission to your surgeon to perform the surgery) will be explained and signed. Our office will review the cost of the procedure (most insurances and Medicare cover much of the cost). Your surgeon will explain the post-operative care and will address any other questions you might have about DALK. You will be asked to use antibiotics and other eye drops before and after your surgery to aid in preventing infection and inflammation.

The surgery is performed under mild sedation. Numbing medication is also used so there is little or no discomfort. Using sophisticated instrumentation the donor cornea is prepared and placed in the recipient’s eye. Similar to a penetrating keratoplasty, the graft is secured using sutures which may or may not be removed postoperatively.

Vision after DALK

Your surgeon will check your healing the day after surgery. Your vision is not expected to be improved immediately at this visit; in fact, it is usually worse on your first post-op day so we ask you to have someone with you who can drive. Some light sensitivity and scratchiness are common and visual recovery can vary. Most patients notice an improvement in their vision during the first two weeks after surgery with continued improvement during the next four to six weeks. This is faster than the many months and often years of rehabilitation needed after a traditional full transplant.  You will likely need a change in your eyeglass prescription at some point after the surgery and we suggest waiting at least eight weeks to do so to ensure there are no visual changes during the course of healing.

The advantages of DALK include reduced rejection rate, reduced risk of late endothelial cell failure, quicker stabilization of the wound and earlier return to unrestricted physical activity. A shorter course of topical steroids (anti-rejection drops) after DALK means faster healing and less risk for steroid-induced glaucoma and cataracts. .