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.
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.
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.
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
Tel 91 40 23607777,  Fax 91 40 23608050 ,24 hours emergency services call 1066
Cornea Clinic
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 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 after DALK.
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.
http://in.youtube.com/watch?v=AimlLnp0hoc
Mr Florin Predun (ff.flo87@yahoo.com), Romania

"I was diagnosed with keratoconus few years ago in both eyes, my vision was very poor, I dropped my studies,I
was very upset & depressed, my life quality was very affected. I read on Internet about Dr Fogla & DALK surgery
& decided to go India. I obtained VISA from Bucharest, & the staff from Apollo hospital was very friendly and
competent. Dr Fogla operated me immediately after 1 day of my arrival, everything was great, My vision is
improved . I am happy , the surgery costs was more than fair. I recommend from all my heart !"