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Deep Anterior Lamellar Keratoplasty (DALK)

Deep Anterior Lamellar Keratectomy or DALK is a newer advanced surgical procedure with significant advantages over a traditional corneal transplant, penetrating keratoplasty. In traditional corneal transplantation, the entire cornea is removed and replaced with a donor cornea.

In DALK, only the diseased anterior or front layers of the cornea are removed and the important, healthy, innermost layer of the cornea (the endothelium) is retained. This is a huge advantage over the traditional corneal transplantation procedure because - by preserving the healthy endothelium – the dreaded complication of rejection and its subsequent loss of corneal clarity are less likely to occur. Rejection is the cause for a large percentage of late transplantation failures in traditional corneal transplantation. This risk is largely eliminated with the DALK procedure.

During the DALK procedure, surgeons separate and remove the anterior layers of the cornea from the innermost layer (endothelium). Once the diseased layers are removed, a donor cornea that has been stripped of the Descemet’s membrane and endothelium is sutured in. DALK is most often used to treat keratoconus and corneal scarring. Like other partial thickness corneal transplant procedures, DALK has some distinct advantages over traditional full thickness corneal transplant surgery including:

  • Fewer post-operative complications
  • Decreased risk of graft rejection and damage
  • Decreased risk of graft failure
  • Decreased risk of intraocular infection
  • Similar visual outcomes with a shorter recovery period

DALK is generally performed on an outpatient basis using local anesthetic and does carry some risks. Because it is a technically precise procedure, perforation of the Descemet’s membrane can occur, sometimes necessitating a full thickness procedure. Other possible complications include inflammation, infection, suture-related problems, and graft rejection.

Talk to your doctor to learn more about DALK and whether you qualify for this partial thickness corneal transplant procedure.


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