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
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
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 - Eye Department - Apollo Hospitals, Jubilee Hills, Hyderabad 500096, Telangana, INDIA |
| Cornea Clinic - toll free number 1600 345 1066, other numbers 91 40 23607777 |
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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.
"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.
"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.
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 !"
"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 !"
| Cornea Clinic |
| Center for Innovative Corneal Surgery |
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