Cursiefen C, Schaub F, Bachmann B. [Update: Deep anterior lamellar keratoplasty (DALK) for keratoconus. When, how and why].
Ophthalmologe 2017;
113:204-12. [PMID:
26832733 DOI:
10.1007/s00347-015-0204-6]
[Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND
The treatment of keratoconus has been significantly expanded in recent years. In addition to the previous options for correction by fitting hard contact lenses and penetrating keratoplasty (PK), corneal cross-linking and lamellar transplantation techniques have been added.
OBJECTIVE
The aim of this review article is to highlight currently available options for minimization of complications and standardization of deep anterior lamellar keratoplasty (DALK) for keratoconus.
MATERIAL AND METHODS
This article summarizes our own data and gives a review of the literature in PubMed.
RESULTS
Performing DALK can provide keratoconus patients with corneal grafts with considerably longer graft survival and a reduced risk of complications.
CONCLUSION
The DALK procedure provides numerous advantages over PK, especially the reduced intraoperative opening of the eye, which thus reduces the risk of serious intraoperative complications. A further benefit is the complete absence of postoperative endothelial immune reactions as the recipient's endothelium remains untouched. The absence of endothelial immune reactions is especially advantageous for young patients with keratoconus and patients with an increased risk of graft rejection, e.g. in atopic dermatitis; however, there are also typical complications of DALK that do not occur during PK. The outlined strategies for standardization of DALK and avoidance of intraoperative and postoperative complications should make DALK safer and more reproducible and lead to possible establishment as a standard procedure in keratokonus.
Collapse