A Partial-Thickness Corneal Transplant

Deep Anterior Lamellar Keratoplasty (DALK) is a partial-thickness corneal transplant that preserves the inner layers of the cornea, making it a safer alternative to Penetrating Keratoplasty (PK) in suitable cases. This procedure replaces only the diseased outer layers of the cornea, leaving the Descemet’s membrane and endothelium intact, which significantly reduces the risk of transplant rejection.

What is Endothelial Keratoplasty?

Endothelial keratoplasty (EK) is a minimally invasive corneal transplant that selectively replaces only the damaged inner layer of the cornea—the endothelium—while leaving the healthy outer layers intact. This targeted approach has revolutionised corneal transplantation, offering faster recovery times, lower rejection rates, and fewer complications compared to full-thickness transplants such as Penetrating Keratoplasty (PK).

Who Can Benefit from DALK?

  1. Keratoconus (Advanced Cases)
  • A progressive condition where the cornea thins and bulges into a cone shape.
  • If the inner corneal layers are unaffected, DALK can restore corneal shape and clarity while lowering the risk of transplant rejection.
  1. Corneal Scarring (Superficial to Mid-Depth Scars)
  • Scarring from injuries, infections, or surgeries can lead to blurry vision and light distortion.
  • DALK can replace the damaged outer layers while preserving the healthy endothelium.
  1. Stromal Dystrophies (Granular or Lattice Dystrophy)
  • Genetic conditions causing opacity or deposits in the cornea, gradually affecting vision.
  • DALK restores corneal transparency without the risks of full-thickness transplants.

Recovery and Healing: What to Expect

  • Sutures stay in place for 18 to 24 months, but vision improves faster than with PK.
  • Full visual stabilisation can take several months to a year.

Discomfort is mild, and patients typically experience less postoperative inflammation than with full-thickness corneal transplants.

Key Benefits of DALK

✔ Lower risk of transplant rejection – The patient’s own endothelium remains, reducing immune system reactions.
✔ Long-lasting results – With proper care, DALK grafts last for decades.
✔ Better safety profile for high-risk patients – Suitable for those with a history of transplant rejection or autoimmune diseases.

Things to Consider Before Choosing DALK

❗ Requires highly skilled surgeons – DALK is a technically complex procedure.
❗ Vision recovery takes time – Full stabilisation may take up to a year.
❗ Possible minor corneal haze – Some patients may experience slight haze or irregularity, especially in cases of severe scarring.