By Shigeto Shimmura, MD
    AAO 2014
    Cornea/External Disease

    Deep anterior lamellar keratoplasty (DALK) is a surgical technique that replaces diseased stromal tissue in eyes with healthy corneal endothelium. The lack of endothelial rejection and a lower risk of endophthalmitis are some of the advantages of DALK over penetrating keratoplasty (PK), and an increasing number of corneal surgeons are reverting to DALK for the treatment of stromal disease. Yet despite the clear benefits of DALK, it is still not the first choice of surgery for many surgeons due to the difficult skills and longer surgery time required compared to PK. Furthermore, a recent report by Coster et al. showed that DALK was associated with worse graft survival and visual acuity compared to PK. Therefore, there are still controversies concerning the evidence of the benefits of DALK over PK.