Descemetocele: DALK may be performed both as a tectonic and optical means to restore ocular integrity.Some common indications for performing DALK include: ĭALK is most useful for treating corneal pathologies in the circumstances of a normally functioning endothelium. Most recently, the forceful intrastromal injection of air or viscoelastic to create a supra-Descemet cleavage plane and reduce the risk of intraoperative perforation was proposed and remains the preferred technique for DALK operations today. Other techniques such as hydrodelamination and manual dissection were subsequently proposed. In 1984, Archila was the first to use air injection to facilitate the creation of a deep stromal plane. Anwar suggested in 1974 that visual outcomes are improved when the donor DM and endothelium are removed, thus creating a smoother interface. In 1959, Hallerman became the first surgeon to perform a deep stromal dissection close to DM and transplant a full-thickness donor button that included DM and endothelium. Paufique later refined the technique by introducing dedicated instruments for stromal dissection. Selective transplantation of a patient’s stroma without the endothelium originated over 150 years ago with the pioneer work of von Hippel and Filatov. The procedure offers advantages over penetrating keratoplasty (PKP), including a “closed-system” operation and a decreased risk of postoperative immune rejection. Recent improvements in surgical instruments and introduction of new techniques of maximum depth of corneal dissection as well as the reduced risk of immunological rejection compared to PK have renewed the interest of corneal surgeons. The Penetrating Keratoplasty (PK) technique largely overshadowed Lamellar Keratoplasty (LK) because LK had poor visual outcomes related to irregularity of the dissected surfaces and scarring in the tissue interfaces. DALK is a partial-thickness corneal transplant which involves only the donor stroma, leaving the recipient's own Descemet's membrane and endothelium.
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