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AbstractDO.17.06 Deep Anterior Lamellar Keratoplasty (DALK) Hille K.1, Kohlhof J. K.2, Löw U.3
1Augenklinik, Ortenauklinikum Offenburg; 2Klinik für Augenheilkunde, Klinikum der Universität Regensburg; 3Augenklinik des Universitätsklinikum des Saarlandes, Homburg/Saar Objective: Deep lamellar Keratoplasty (DALK) is alternative to penetrating kertoplasty (PKP) in pathologies of corneal stroma. The advantage of this method is to save the own endothelium cells not involved in the disease. In this technique there is no risk for acute and chronic graft rejection. In between the interface of the donor and recipient material there may occur hace ore scars. Therefore one tries to prepare on the descemets membrane as near as possible ore even direct upon it. For this various surgical techniques had been invented.
Methods: We will focus on the classical mechanical lamellar procedure as well as the hydrodelamination und big-bubble technique of Anwar.
Results: As a rule preparation and removal of the stroma from (epidescemetal) or at least near the descemets membrane can be done successfully with such a technique. Interface problems will be less in epidescemetal removal of the stroma. Perforations of the descemets membrane leading to a PKP are seldom. Mikroperforations are more frequent (between 9% (big bubble) and 35% (hydrodelamination, mechanical technique)), but DALK will be possible in most of them. In a comparison study with DALK and PKP in keratoconus we found no significant difference regarding postoperative visual acuity and astigmatism, but in DALK visual rehabilitation was quicker than in PKP.
Conclusions: Because of the good results after deep lamellar KPL we suggest a deep lamellar procedure if there is an indication for KPL in an intact endothelium. Indications for a DALK are stromal opacifications (scars, dystrophies), keratoconus (without previous episodes of hydrops), high astigmatism following refractive procedures and severe corneal ulceration.
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