Clinical evaluation of Deep Anterior Lamellar Keratoplasty (DALK)

Background: Keratoconus is a progressive, non-inflammatory corneal ectasia with central thinning. The aim of this work was to evaluate intra and post-operative complications final visual outcome deep anterior lamellar keratoplasty (DALK).Methods: This prospective cohort interventional study carried out on 20 patients aged from 65 years old superficial stromal opacities based clinical examination AS-OCT (anterior segment optical coherence tomography), advanced keratoconus thickness below 400 microns or the presence scarring in axis. Results: Descemet's membrane (DM) perforation encountered 7 eyes attempted DALK (35%). Early epithelial defect happened 13eyes post operatively mostly due surgical manipulation grafts, 2 them (10%) continue 3 months operatively. Five developed DM folds, three (15%) Urrets-Zavalia syndrome, one eye 5% cortical cataract, four (20%) had interface haze. Best corrected acuity (BCVA) affected case improved all cases 85% achieved 0.5 more after year postoperative. Double chamber (AC) found five (25%). two were successfully managed single air injection.one needed Endothelial Keratoplasty. mean recipient bed 42.850±8.869 um. Average K decreased significantly postoperatively. A low myopia at 6 postoperatively.Conclusions: led reasonable postoperative refractive outcome, patient age, peripheral descemet's fold, failed pneumatic dissection has no significant impact acuity. Risk detachment, haze double AC hemorrhage during trephination are main complications.