Deep Anterior Lamellar Keratoplasty (DALK)
Although similar to a full-thickness PK procedure, a DALK (Deep Anterior Lamellar Keratoplasty) replaces only the top and middle layers of the cornea, leaving the very inner layer intact. As a result, the healing time and the risk of the body rejecting the cornea are decreased.
Endothelial Keratoplasty (DSEK, DSAEK & DMEK)
A DSEK procedure (Descemet’s Stripping Endothelial Keratoplasty) is a special type of transplantation, replacing just the back portion of the cornea with healthy donor tissue. The cornea has five layers and the deepest layer is delicate and can be damaged in diseases such as Fuchs Dystrophy, Pseudophakic Bullous Keratopathy (PBK), Aphakic Bullous Keratopathy (ABK), and Posterior Polymorphous Dystrophy (PPMD).
There are a few different kinds of Endothelial Keratoplasty, such as DSEK, DSAEK or DMEK. Your surgeon will review the options with you and make his or her recommendation at your evaluation.
During the procedure, the thin endothelial layer is removed from the rest of the cornea. The donor endothelium will be attached to a thin layer of donor cornea, then folded and inserted through a small incision. An air bubble is injected to push the donor cornea up against the posterior surface of your cornea. The pumping action of the new donor endothelium helps bond the donor tissue to your own cornea.
This procedure is an excellent alternative to a full-thickness transplant in certain patients that have a healthy cornea except for the back layer. Patients often experience a faster visual recovery, less astigmatism, and minimal stitches compared to a full-thickness transplant. In addition, this surgery can be combined with cataract surgery.
Like any corneal transplant procedure, there is still some risk of infection or rejection of the new donor tissue, so taking your medications properly and careful follow-up examinations are important.