Deep anterior lamellar keratoplasty, or DALK in short, is a type of corneal transplant operation. In DALK, the eye surgeon replaces the damaged front layers of the cornea. The surgeon leaves the back layer, called the endothelium, alone.
 

How DALK Is Different From PKP
 

In a standard corneal transplant called penetrating keratoplasty (PKP), the surgeon removes and replaces the entire cornea. This includes taking out the endothelium, which is the back lining layer. With DALK, the surgeon is cautious not to disturb the endothelium. Only the diseased outer layers get replaced. Saving the endothelium gives patients a significantly better prognosis.

The endothelium is a thin sheet of cells on the inner surface of the cornea. It keeps the cornea clear and hydrated. Without a healthy endothelium, the cornea would become cloudy and swell, severely reducing vision.
 

In PKP, the surgeon must completely remove and discard the endothelium and the rest of the cornea. The patient must then rely on donor endothelium, which has a chance of tissue rejection.
 

With DALK, peeling off only the abnormal outer corneal layers avoids damaging the patient’s native endothelium. This maintains proper corneal function and clarity. Leaving the endothelium intact lowers the risk of rejection and other complications after surgery.
 

Why Keeping the Endothelium Is Helpful

Leaving the endothelium in place offers many benefits over removing it, like in PKP:

·      There is a lower chance of new cornea rejection.

·      Vision improves after surgery.

·      Much faster recovery time.

·      Fewer problems after the operation.
 

Who Should Get DALK Surgery?

DALK may help people with eye conditions limited to the front of the cornea. These include:

·      Keratoconus — thin bulging cornea.

·      Fuchs’ dystrophy, which involves endothelium cells breaking down.

·      Cornea scars from injury or infection.

·      Cornea thinning disorders like pellucid marginal degeneration.

·      Failed previous corneal transplant.

·      Children under the age of two.

The key consideration is if the disease is restricted only to the outer cornea. Your eye doctor decides if you qualify for DALK.
 

What to Expect During the DALK Surgery

DALK takes place in the operating room under general anesthesia. The eye surgeon starts by making a small cut in the cornea. They then insert a tool to separate the abnormal outer layers from the endothelium gently.
 

The surgeon removes and replaces the damaged layers with healthy donor corneal tissue. This new graft is smoothly attached in place, and the surgical incision is closed. Right after surgery, vision is very blurry but gets better over weeks.
 

What Is Recovery Like After DALK?

While intensive at first, DALK recovery is quicker than PKP. Patients can usually go home the same day. Complete vision rehab takes around three to six months. Medicines control pain and prevent rejection, while eye drops lubricate and promote healing.
 

Follow-up visits monitor progress. You should avoid rubbing the eyes or straining them during recovery. As the swelling reduces, your eyesight steadily improves. Close follow-up with your doctor will help ensure the best outcome.
 

In cornea conditions limited to the outer layers, DALK gives better results and a much faster return to everyday life than PKP. As surgical skills progress, selective DALK is becoming the preferred technique for corneal restoration. Ask your eye doctor if DALK might help you.
 

For more on DALK surgery, visit Sacramento Eye Consultants at our offices in Sacramento or Lincoln, California. Call (916) 915-0300 to schedule an appointment today.