Deep Anterior Lamellar Keratoplasty in Keratoconus

Introduction Deep anterior lamellar keratoplasty (DALK) is intended for the surgical treatment of corneal pathology without the involvement of the endothelium. Sparing of the healthy host endothelium for lifetime is of utmost importance in young patients. Therefore, keratoconus is among the main indications for DALK. Outline of Cases Two men, 22 and 28 years of age, underwent DALK for the treatment of progressive keratoconus, with low visual acuity, impossible to be corrected with gas-permeable contact lenses, due to the extreme conical protrusion of the cornea. Baring of Descemet's membrane was achieved with lamellar dissection and peeling off the stroma. An 8.5 mm graft without the endothelium was sutured into an 8.0 mm bed. Both grafts remained clear and attached, without either ocular surface pathology or problems arising from sutures. The best corrected visual acuity was 20/25 and 20/40, with the astigmatism of 2.5 and 3.0 diopters, respectively. The follow-up was one year. Conclusion This is the first presentation of DALK in our literature. The restoration of corneal transparency and stability, with sparing of the host endothelium, has put DALK among successful corneal tranplantation procedures. Together with Descemet stripping endothelial keratoplasty, which already accounts for almost a half of all our keratoplasties, it offers an alternative to penetrating keratoplasty.