Deep anterior lamellar keratoplasty in the management of keratoconus

• Main Author: Rajesh Fogla
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2013-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Epidemiology; keratoconus; prevalence; Disease pathogenesis; genetic heterogeneity; genetics and genomics; genome-wide association study; genomic loci; linkage mapping; molecular mechanisms; whole exome-genome sequencing; Deregulation; ectasia; gene expression; mass spectroscopy; proteomics; signaling pathways; Cornea; crosslinking; modulus; Corneal topography; imaging; optical coherence tomography; placido disc based topography; Ectatic disease; scheimpflug imaging; Keratoconus; ocular allergy; vernal keratoconjunctivitis; Contact lens; piggy back contact lenses; rigid gas permeable; scleral lens; SynergEyes; toric soft contact lens; Corneal cross-linking techniques; new technologies; riboflavin; Collagen cross linking; Corneal collagen cross-linking; hypoosmolar riboflavin; thin cornea; transepithelial collagen cross-linking; Corneal cross-linking; radiant exposure; ultraviolet-A; Accelerated corneal cross linking; corneal laser surgery; corneal ectasia; UV light; Laser in situ keratomileusis surgery; very high fluence collagen cross-linking; corneal ectosia; LASIK ectosia prophylaxis; Cornea collagen cross linking; long term results; Corneal collagen cross linking; corneal transplant; pediatric keratoconus; Collagen cross-linking; microbial keratitis; fungus; acanth; topography-guided custom ablation treatment; treatment; Intrastromal corneal rings segments; Implantable collamer lens; intra corneal ring implants; keratoconous; toric implantable collamer lens; Acute corneal hydrops; corneal edema; Deep anterior lamellar keratoplasty; lamellar keratoplasty; penetrating keratoplasty
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2013;volume=61;issue=8;spage=465;epage=468;aulast=Fogla

Advanced cases of keratoconus often require surgical intervention to restore corneal anatomy and improve eyesight. Penetrating keratoplasty (PK) although commonly performed has potential risk of immunological rejection and is now no longer automatically the first choice of surgery. DALK procedures have evolved, which allows surgical replacement of recipient′s corneal stroma, leaving behind healthy descemet membrane (DM) and endothelium. This reduces the risk of allograft endothelial rejection and late graft failure. In recent times, DALK techniques have led to significant improvements in visual outcome and current results are comparable to PK. Big bubble technique of DALK has become the most popular among the various surgical techniques described. Manual near DM DALK also gives good outcome although the visual recovery is often delayed. Future integration of femtosecond laser technology along with diagnostic imaging technology is likely to further improve outcomes of DALK in keratoconus.