Transplant - DALK

You will benefit from a keratoplasty, what should you know about the surgery?

There are different types of keratoplasties:

  • Penetrating Keratoplasty in which the entire cornea is replaced.

  • Anterior Lamellar Keratoplasty (DALK, PDALK)) in which the entire cornea is replaced except a small layer called endothelium.

  • Endothelial Keratoplasty (DMEK) in which only the corneal endothelium is replaced.

Which Keratoplasty is indicated for you ?

 

  • In more than 60% of the cases, only the corneal endothelium is abnormal (Fuchs dystrophy, Pseudophakic bullous keratopathy).  A DMEK (Descemet Membrane Endothelial Keratoplasty) is indicated.

  • In 20% of the cases, the anterior part of the cornea is abnormal (as in Keratoconus). A DALK (Deep Anterior Lamellar Keratoplasty) is indicated.

  • When the entire cornea is abnormal, a penetrating keratoplasty aimed to replace the complete cornea is indicated.

Surgery

  • The operation usually occurs under general anesthesia.  One night admission is sometime needed.

  • After the surgery, and eyepatch will cover your eye.

  • There is no pain but a foreign body / burning sensation.

  • In case of intense pain and nausea, it’s important to have your eye checked by your doctor. Pain is usually caused by an increase in intra ocular pressure that might occur in the first hours after the surgery. Adequate treatment need to be started.

First day after the surgery

  • Your surgeon will remove the eye patch and open your eye. An eye exam is performed to evaluate the graft and the sutures.

  • It’s normal to have foreign body sensation and tearing during the first few days.

  • Visual Acuity is still blurry.

First week after the surgery

  • During this first week, foreign body sensations and tearing will slowly decrease.

  • You need to strictly respect the prescribed treatment (antibiotics and steroids eyedrops).

  • Visual Acuity is still blurry and will slowly improve starting one month.

First month after the surgery

  • There is no more pain or foreign body sensation.

  • Visual Acuity starts to improve,

  • Steroids eye drops should be used to avoid rejection and intra ocular pressure will be monitored by your surgeon.

Visual Acuity stabilizes after few months but is usually limited by astigmatism. Sutures removal occurs 9 to 12 months after the surgery and will allow decrease and control of the remaining astigmatism.

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