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Review
. 2024 Feb 23;14(1):34-43.
doi: 10.4103/tjo.TJO-D-23-00175. eCollection 2024 Jan-Mar.

Main issues in deep anterior lamellar keratoplasty: A systematic narrative review

Sana Niazi  1   2 , Jorge Alió Del Barrio  3 , Farideh Doroodgar  1   2 , Mohammad Ali Javadi  4 , Jorge L Alió  5   6
Affiliations
Review

Main issues in deep anterior lamellar keratoplasty: A systematic narrative review

Sana Niazi et al. Taiwan J Ophthalmol. .

Abstract

Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK's advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet's membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK's lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK's role as a transformative force in the field.

Keywords: Cornea; femtosecond; keratoconus; keratoplasty; lamellar.

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Conflict of interest statement

Prof. Jorge L. Alió, an international editorial board member at Taiwan Journal of Ophthalmology, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper..

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses
Figure 2
Figure 2
Preoperative optical coherence tomography-guided management for deep anterior lamellar keratoplasty in keratoconus. OCT = Optical coherence tomography, SD-OCT = Spectral domain OCT, DALK = Deep anterior lamellar keratoplasty
See this image and copyright information in PMC

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