Deep Anterior Lamellar Keratoplasty (DALK) Cost in India - Get Cost Estimate

What Is Deep Anterior Lamellar Keratoplasty (DALK)?

Deep Anterior Lamellar Keratoplasty, commonly referred to as DALK, is an advanced form of corneal transplant surgery. Unlike full-thickness corneal transplantation (penetrating keratoplasty), DALK specifically replaces only the front layers of the cornea, preserving the patient’s healthy Descemet’s membrane and endothelium. This technique is particularly effective for individuals with corneal diseases that do not affect the innermost layers of the cornea, such as keratoconus, corneal scars, and certain stromal dystrophies. By maintaining the patient’s own endothelium, DALK significantly reduces the risk of graft rejection and provides excellent visual outcomes.

Why Is DALK Performed?

DALK is performed when the front layers of the cornea are damaged or diseased but the endothelial layer remains healthy and functional. Conditions like keratoconus, anterior corneal scarring, and some forms of corneal degeneration or dystrophy are ideal indications for this procedure. The primary goal of DALK is to improve visual acuity and corneal transparency while minimizing the risks associated with full-thickness corneal transplant. By selectively replacing only the diseased stromal tissue, DALK helps restore the patient’s vision while preserving more of their natural eye structure.

How Is DALK Different From Traditional Corneal Transplants?

The key difference between DALK and traditional full-thickness transplants lies in the layers of the cornea that are replaced. In penetrating keratoplasty, all five layers of the cornea, including the endothelium, are removed and replaced. In contrast, DALK retains the patient’s own endothelium and Descemet’s membrane. This reduces the chances of endothelial rejection, which is the most common cause of graft failure in corneal transplants. DALK also has a lower risk of intraocular complications and better long-term graft survival, making it a safer and more conservative surgical option.

What Happens During the DALK Procedure?

The DALK procedure is typically performed under local or general anesthesia. The surgeon begins by carefully removing the outer and middle layers of the cornea, down to the Descemet’s membrane. This is a delicate process that requires high surgical precision to avoid perforating the underlying layers. Once the diseased stroma is removed, a donor cornea prepared without the endothelial layer is sutured onto the remaining healthy corneal tissue. The surgery usually takes between 60 to 90 minutes and is performed on an outpatient basis, meaning the patient can return home the same day.

What Is Recovery Like After DALK?

Recovery after DALK is generally smoother and involves fewer complications than full-thickness corneal transplants. Most patients can resume light activities within a few days, although complete visual recovery may take several months. Post-surgery, the eye may feel mildly irritated or sensitive to light. Patients are prescribed antibiotic and anti-inflammatory eye drops to prevent infection and inflammation. Follow-up visits are crucial to monitor healing, remove sutures when necessary, and ensure that the graft remains stable and clear.