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Deep anterior lamellar keratoplasty preserves the patient's own endothelium, whereas penetrating keratoplasty replaces the full corneal thickness. A Cochrane systematic review of randomized studies comparing the two procedures for moderate-to-severe keratoconus found no clear difference in visual acuity or refractive outcomes between DALK and penetrating keratoplasty. The evidence was limited by only two completed studies and a number of DALK procedures that had to be converted because of technical difficulty. Clinically, the potential advantages of DALK include preservation of host endothelium and avoidance of endothelial rejection, but the technique has a meaningful learning curve. For HCPs, the review supports offering DALK as a viable alternative when the pathology is predominantly anterior and the surgeon has the necessary technical expertise. Penetrating keratoplasty remains appropriate in cases with deep stromal scarring or endothelial involvement. The findings fit AIOC's dedicated DALK and lamellar corneal surgery content.
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Deep anterior lamellar keratoplasty preserves the patient's own endothelium, whereas penetrating keratoplasty replaces the full corneal thickness. A Cochrane systematic review of randomized studies comparing the two procedures for moderate-to-severe keratoconus found no clear difference in visual acuity or refractive outcomes between DALK and penetrating keratoplasty. The evidence was limited by only two completed studies and a number of DALK procedures that had to be converted because of technical difficulty. Clinically, the potential advantages of DALK include preservation of host endothelium and avoidance of endothelial rejection, but the technique has a meaningful learning curve. For HCPs, the review supports offering DALK as a viable alternative when the pathology is predominantly anterior and the surgeon has the necessary technical expertise. Penetrating keratoplasty remains appropriate in cases with deep stromal scarring or endothelial involvement. The findings fit AIOC's dedicated DALK and lamellar corneal surgery content.
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