Deep Anterior Lamellar Keratoplasty (DALK)
A variety of corneal conditions can affect the clarity or shape of the cornea. Traditionally full thickness corneal
transplantation procedures are being commonly performed to restore corneal shape and clarity and thereby improving
vision.
In most of these corneal conditions, the innermost layer of the cornea - the endothelium is usually healthy. (This is the
functional layer of the cornea, that contains cells that pump fluid out of the cornea and maintain its clarity.) However in
full thickness corneal transplantation procedures (conventional corneal grafting surgery) this layer is also sacrificed
and replaced with donor tissue. The body senses this layer as being non self ie foreign and attempts to reject this
tissue. Hence post operative steroid medications are necessary for a long term duration to prevent rejection of the
corneal graft. Long term use of steroids can predispose to complications such as cataract and glaucoma, besides the
increased risk of secondary infections.
Deep anterior lamellar keratoplasty (DALK), is a newer method of corneal surgical procedure that selectively
removed the diseased anterior layers of the cornea and retains the healthy innermost layer (endothelium). As the inner
layer is retained the body does not recognize the donor tissue, hence there is no risk of rejection, and steroid
medications need not be continued for a long duration.
A variety of corneal conditions can affect the clarity or shape of the cornea. Traditionally full thickness corneal
transplantation procedures are being commonly performed to restore corneal shape and clarity and thereby improving
vision.
In most of these corneal conditions, the innermost layer of the cornea - the endothelium is usually healthy. (This is the
functional layer of the cornea, that contains cells that pump fluid out of the cornea and maintain its clarity.) However in
full thickness corneal transplantation procedures (conventional corneal grafting surgery) this layer is also sacrificed
and replaced with donor tissue. The body senses this layer as being non self ie foreign and attempts to reject this
tissue. Hence post operative steroid medications are necessary for a long term duration to prevent rejection of the
corneal graft. Long term use of steroids can predispose to complications such as cataract and glaucoma, besides the
increased risk of secondary infections.
Deep anterior lamellar keratoplasty (DALK), is a newer method of corneal surgical procedure that selectively
removed the diseased anterior layers of the cornea and retains the healthy innermost layer (endothelium). As the inner
layer is retained the body does not recognize the donor tissue, hence there is no risk of rejection, and steroid
medications need not be continued for a long duration.
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| DALK in Keratoconus |
| Keratoconus patients with good unaided vision following DALK surgery. None of them are using contact lenses anymore |
| Clear corneal graft following DALK procedure |
| Advanced Keratoconus, note the extreme corneal thinning |
| Normal corneal contour after DALK procedure |
Mr Sumit (sumitdude@yahoo.com) , Assam, India
"I had advanced keratoconus in both eyes, and was not able to wear contact lens in both eyes for the past
21/2 years....The surgery was very comfortable....I feel like I have got perfect vision for my operated eye
which was lacking for the past 10 years...It feels like a second life"
Mr Sumit, had advanced keratoconus in both eyes. He underwent successful DALK procedure in both his
eyes. unaided vision 6/18 right eye improving to 6/9 with glasses, and 6/9 unaided vision in the left eye
improving to 6/6 with glasses following surgery.
"I had advanced keratoconus in both eyes, and was not able to wear contact lens in both eyes for the past
21/2 years....The surgery was very comfortable....I feel like I have got perfect vision for my operated eye
which was lacking for the past 10 years...It feels like a second life"
Mr Sumit, had advanced keratoconus in both eyes. He underwent successful DALK procedure in both his
eyes. unaided vision 6/18 right eye improving to 6/9 with glasses, and 6/9 unaided vision in the left eye
improving to 6/6 with glasses following surgery.
| Milind (Kolkata) DALK left eye unaided vision 6/9 (20/30) |
Mr Ankit (aksonly4u@rediffmail.com), Jaipur, Rajasthan
"I had very less vision in the left eye, semisoft lens did not suit me, I was advised to undergo the
conventional corneal transplantation procedure...DALK procedure was not a problem at all....I feel my
unaided vision has improved to 90% of normal"
Mr Ankit, had advanced keratoconus in the left eye. He underwent successful DALK procedure in his left
eye.. unaided vision 6/9 improving to 6/6 with glasses following surgery.
"I had very less vision in the left eye, semisoft lens did not suit me, I was advised to undergo the
conventional corneal transplantation procedure...DALK procedure was not a problem at all....I feel my
unaided vision has improved to 90% of normal"
Mr Ankit, had advanced keratoconus in the left eye. He underwent successful DALK procedure in his left
eye.. unaided vision 6/9 improving to 6/6 with glasses following surgery.
| Archana (Mumbai) DALK left eye unaided vision 6/9 (20/30) |
| Ahmed (Kerala) DALK left eye unaided vision 6/9 (20/30) |
| Note clear cornea with normal curvature following DALK |
| Postoperative Corneal Topography - Note normal corneal contour |
| Preoperative Corneal Topography - Note advanced keratoconus |
| Keratoconus was the greatest pain in my life. Contact lenses were the only solution for my vision but with lenses there were limitations in my day-to-day life. I visited many doctors but I was told to continue with lenses till it was bearable. The other solution was total cornea transplant. As per doctors opinion, the success rate was low & in case of failure could lead to blindness. I was asked to be mentally prepared for this worst situation. Luck was on my side & incidentally I came to know about the treatment being done by Dr. Fogla & I immediately contacted him. After hearing his confident tone & the experience quoted, I decided to go for DALK surgery on my right eye. The post surgery days were absolutely painless & no pain killer was required. Now my life is totally changed. I can see with my operated eye clearly without any aid. The impossible had become possible just like magic. I am now leading a normal life. Thanks to Dr. Fogla for his surgical expertise for such kind of operations. Thanks to Apollo hospital for providing the necessary infrastructure & courteous staff. Mrs Joshi underwent deep anterior lamellar keratoplasty in both her eyes. She now enjoys good vision in both eyes without the need for contact lenses etc. Her unaided vision is good, and improves to 6/6 ie 20/20 with glasses. She finally underwent LASIK procedure in one eye to improve her unaided vision. (You can reach Mrs Joshi at the following email id mrudul4807@gmail.com) |
| Awath Wahida (Kenya) DALK done both eyes unaided vision 6/18 (20/60), improving to 6/9 (20/30) with glasses |
| Understand the DALK procedure Click here to view animation |
| Mr Rajitha, 16 year old boy from Sri Lanka, had advanced keratoconus in both his eyes. Unable to tolerate contact lenses, he had considered giving up his studies due to poor vision. He underwent deep anterior lamellar keratoplasty in both his eyes and now has 6/6 vision with glasses in both his eyes. He is back to his classes and looks ahead at a bright future. |
| DALK in Corneal scars |
| Corneal scarring with thinning following Fungal Keratitis |
| Note high astigmatism, with irregular topography and flattening at the site of corneal scarring |
| Normal corneal contour is restored following the DALK procedure |
| Note clear cornea following DALK procedure |
| Note resolution of astigmatism, and regular appearance of the corneal topography following DALK |
| 52 year old man with central corneal scar, thereby affecting his vision. DALK procedure performed successfully in the affected eye. Note clear cornea following surgery. Patients vision was restored to normal in the operated eye. |
For more information on this specialized corneal surgical procedure call us or send us an email to schedule an appointment
Dr Rajesh Fogla DNB, FRCS, MMed has been performing specialized lamellar corneal surgery since 1998. He was the first surgeon to
introduce Deep lamellar endothelial keratoplasty procedure (DLEK) in India. He has published several papers in international journals on
lamellar corneal surgery, and has delivered lectures on the same topic on numerous occasions both national and international
symposiums. He has conducted instruction courses on lamellar corneal surgery also at international and national symposiums.
Dr Fogla is available in the clinic on weekdays between 9am to 5pm, ( 6 - 8 pm with prior appointments only)
You can reach him on +91 9866076750 or dr_fogla@yahoo.com
Dr Rajesh Fogla DNB, FRCS, MMed has been performing specialized lamellar corneal surgery since 1998. He was the first surgeon to
introduce Deep lamellar endothelial keratoplasty procedure (DLEK) in India. He has published several papers in international journals on
lamellar corneal surgery, and has delivered lectures on the same topic on numerous occasions both national and international
symposiums. He has conducted instruction courses on lamellar corneal surgery also at international and national symposiums.
Dr Fogla is available in the clinic on weekdays between 9am to 5pm, ( 6 - 8 pm with prior appointments only)
You can reach him on +91 9866076750 or dr_fogla@yahoo.com
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| Tel 91 40 23607777, Fax 91 40 23608050 ,24 hours emergency services call 1066 |
Cornea Clinic
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| Cornea Clinic - Eye Department - Apollo Hospitals, Jubilee Hills, Hyderabad 500 033, A P, INDIA |
| Cornea Clinic - toll free number 1600 345 1066, other numbers 91 40 23608333 / 23548888 / 23606655 |
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Mr Mohammed (ghousebasha_jrb@yahoo.co.in), Mumbai, India
"I thought that I will lose my vision after some days as many of the doctors whom I consulted said that there
is no treatment for keratoconus and conventional surgery is the only remedy to get good vision for me.
Now I am very happy that I don’t have keratoconus in both my eyes and I can see things clearly like
everyone. I would like to thank you once again for giving me good treatment."
Mr Mohammed, had advanced keratoconus in both eyes. He underwent successful DALK procedure in
both his eyes. unaided vision 6/9+ right eye, and 6/12 unaided vision in the left eye improving to 6/6 with
glasses following surgery.
"I thought that I will lose my vision after some days as many of the doctors whom I consulted said that there
is no treatment for keratoconus and conventional surgery is the only remedy to get good vision for me.
Now I am very happy that I don’t have keratoconus in both my eyes and I can see things clearly like
everyone. I would like to thank you once again for giving me good treatment."
Mr Mohammed, had advanced keratoconus in both eyes. He underwent successful DALK procedure in
both his eyes. unaided vision 6/9+ right eye, and 6/12 unaided vision in the left eye improving to 6/6 with
glasses following surgery.
Mr Siddarth (shettysiddarth@yahoo.com), Delhi, India
"I underwent DALK procedure in my left eye.. Prior to that i was seeing 4/60 in my left eye. The surgery
was a breeze.. and I walked out of the hospital the same day. Within 3 weeks I was seeing much better
than before. After 3 months i am seeing 6/9 ie 20/30 in my left eye. I am exceptionally happy at taking the
DALK route.. In case any of you reading this post want more information regarding my experience please
do not hesitate to contact me"
Mr Siddarth had advanced keratoconus in his left eye. He underwent DALK procedure in his left eye which
improved his vision to 6/9 ie 20/30.
"I underwent DALK procedure in my left eye.. Prior to that i was seeing 4/60 in my left eye. The surgery
was a breeze.. and I walked out of the hospital the same day. Within 3 weeks I was seeing much better
than before. After 3 months i am seeing 6/9 ie 20/30 in my left eye. I am exceptionally happy at taking the
DALK route.. In case any of you reading this post want more information regarding my experience please
do not hesitate to contact me"
Mr Siddarth had advanced keratoconus in his left eye. He underwent DALK procedure in his left eye which
improved his vision to 6/9 ie 20/30.
| http://in.youtube.com/watch?v=AimlLnp0hoc |