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DALK — Deep Anterior Lamellar Keratoplasty

DALK replaces the diseased front layers of the cornea while preserving the patient's own healthy inner layer (endothelium). Because the endothelium is retained, the risk of endothe…

DALK — Deep Anterior Lamellar Keratoplasty — specialist eye care at Sentra Clinic & Hospital, Mumbai
Specialist eye care at Sentra Clinic & Hospital, Malad East, Mumbai.
Quick Answer

DALK replaces the diseased front layers of the cornea while preserving the patient's own healthy inner layer (endothelium). Because the endothelium is retained, the risk of endothelial graft rejection is largely eliminated. It is most often used for keratoconus and stromal scars with a healthy endothelium.

What is DALK?

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Deep Anterior Lamellar Keratoplasty is a partial-thickness corneal transplant. The surgeon removes the corneal epithelium and stroma — the layers where keratoconus and most scars live — down to (or near) Descemet's membrane, and sutures a donor graft of the same front layers in place. The patient's own Descemet's membrane and endothelium remain untouched.

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Which layer is replaced — and why it matters

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The endothelium is the cornea's non-regenerating pump layer and the main target of graft rejection. Keeping your own endothelium means the most dangerous form of rejection is largely eliminated, long-term steroid needs are often lower, and the graft is not dependent on donor endothelial cell counts.

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When DALK may be considered

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  • Advanced keratoconus with scarring or contact-lens intolerance
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  • Stromal scars from healed infection or trauma with a healthy endothelium
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  • Stromal dystrophies (e.g. lattice, granular) affecting vision
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DALK is not suitable when the endothelium itself is diseased (e.g. Fuchs dystrophy, endothelial failure) — those eyes need endothelial keratoplasty such as DSAEK instead. A full-thickness PK may be needed if Descemet's membrane is involved (e.g. after hydrops with a tear).

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DALK vs full-thickness transplant (PK)

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DALKPK
EndotheliumPatient's own — retainedDonor — replaced
Endothelial rejectionLargely eliminatedPossible; leading cause of late failure
Wound strengthStronger; eye keeps its own back layerFull-thickness wound
SurgeryTechnically more demandingMore standardised
Visual outcomeComparable in suitable eyesComparable
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Limitations

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  • Technically challenging; occasionally the deep layer perforates and conversion to PK is required.
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  • Not appropriate when the endothelium is diseased.
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  • Visual recovery still takes months, and suture-related astigmatism may need later correction.
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Recovery

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Sutures typically remain for 12–18 months and may be selectively removed to fine-tune astigmatism. Vision improves gradually over months. The same RSVP rejection-warning rules apply (stromal rejection is rare but possible), and periodic lifelong review continues.

Information on this page is for general education and does not replace an examination, diagnosis or personalised medical advice from a qualified eye-care professional.

FAQs: DALK — Deep Anterior Lamellar Keratoplasty

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