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Deep Anterior Lamellar Keratoplasty: How to Avoid Conversion to Penetrating Keratoplasty

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Keratoconus

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Abstract

Deep anterior lamellar keratoplasty involves removal of the damaged corneal stroma retaining the patient’s healthy Descemet’s membrane (DM) and endothelium, reducing the risk of rejection and endothelial cell loss, with a consequent longer graft survival. It is a technically more challenging and time-consuming procedure with a deep learning curve. To be perfectly performed, DALK demands greater surgeon experience and skills than penetrating keratoplasty (PK), due to difficulty in separating stroma from the DM without perforating it, avoiding the conversion to PK. Improvements in the technique and the knowledge acquired in recent years help increase the successful rates. Technologies, proper instruments, and surgeon training are helpful to achieve deeper depth cleavages and the big-bubble formation, as well as perform other surgical steps successfully. Rescue techniques should be known in the event of perforation, trying to keep the advantages of DALK.

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Authors and Affiliations

  1. Doctoral Degree, Federal University of São Paulo, São Paulo, SP, Brazil

    Adriana dos Santos Forseto

  2. Sorocaba Eye Hospital, Sorocaba, SP, Brazil

    Adriana dos Santos Forseto & Lycia Maria Martins Pinho Pedral Sampaio

  3. Sorocaba Eye Bank, Sorocaba, SP, Brazil

    Adriana dos Santos Forseto

  4. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

    Lycia Maria Martins Pinho Pedral Sampaio

  5. University of São Paulo, São Paulo, SP, Brazil

    Lycia Maria Martins Pinho Pedral Sampaio

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  1. Adriana dos Santos Forseto
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Editors and Affiliations

  1. Provisão Eye Hospital of Maringá, Maringá, Paraná, Brazil

    Edna Almodin

  2. Federal University of São Paulo, São Paulo, São Paulo, Brazil

    Belquiz Amaral Nassaralla

  3. Nucleo de Medicina Ocular, Goiânia, Goiás, Brazil

    Jordana Sandes

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dos Santos Forseto, A., Sampaio, L.M.M.P.P. (2022). Deep Anterior Lamellar Keratoplasty: How to Avoid Conversion to Penetrating Keratoplasty. In: Almodin, E., Nassaralla, B.A., Sandes, J. (eds) Keratoconus . Springer, Cham. https://doi.org/10.1007/978-3-030-85361-7_78

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