Southport, Robina & Coolangatta:  07 5557 8888  |  Fax:  07 5557 8899
OUTLOOK EYE TREATMENTS

Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Understanding Corneal Transplant Surgery:

Corneal transplant surgery is a procedure performed to replace a damaged or diseased cornea with a healthy donor cornea. There are different types of corneal transplant surgeries, including penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). This pamphlet aims to provide you with essential information about these procedures, including their risks and benefits.

Penetrating Keratoplasty (PK):

In PK, the entire thickness of the cornea is replaced with a donor cornea. This procedure is typically recommended for conditions that affect all layers of the cornea, such as corneal scarring, some cases of keratoconus, or corneal dystrophies.

Deep Anterior Lamellar Keratoplasty (DALK):

DALK involves the replacement of the outer layers of the cornea while leaving the innermost layer, known as the endothelium, intact. It is primarily used to treat conditions that affect the outer layers of the cornea, such as keratoconus or outer layer corneal scars.

Benefits of Surgery:

Corneal transplant surgery can provide significant benefits for individuals with corneal conditions. Some of the potential benefits include:

Improved Vision: The goal of corneal transplant surgery is to improve your vision and correct any visual impairments caused by corneal diseases or injuries.

Restored Corneal Function: Corneal transplantation can restore the normal structure and function of the cornea, allowing it to properly focus light onto the retina and improve visual clarity.

Enhanced Quality of Life: Improved vision and relief from corneal symptoms can significantly enhance your quality of life, allowing you to engage in daily activities with greater ease and confidence.

Risks of Surgery:

As with any surgical procedure, there are risks involved with the a corneal transplant which can cause vision reduction or loss. Fortunately severe complications are uncommon and many complications can be treated. Some potential risks include infection, transplant rejection, graft failure and need for a repeat transplant, astigmatism (a glasses error), elevated eye pressure or damage to the graft from trauma.

Summary:

Corneal transplant surgery can be a life-changing procedure for individuals with corneal conditions. At your appointment we will have a thorough discussion to help you understand the surgery based on your unique circumstances. This will provide you with a personalized recommendation and guidance to help you make an informed decision regarding your eye health.

A corneal transplant is a remarkable surgical procedure that can restore vision and improve your quality of life. Dr Brett Drury is a corneal specialist who performs all types of corneal transplants at Outlook Eye Specialists.

Frequently Asked Questions

Penetrating keratoplasty (PK) is a full-thickness corneal transplant in which all five layers of the patient’s cornea are removed and replaced with a full-thickness disc of healthy donor tissue. It is used when disease affects the full thickness of the cornea and cannot be treated with a partial-thickness technique.
DALK is a partial-thickness corneal transplant that replaces the anterior stroma (the main structural layer of the cornea) while preserving the patient’s own Descemet’s membrane and endothelium. By retaining the patient’s own endothelium, DALK has a significantly lower rejection rate than penetrating keratoplasty and avoids the risk of endothelial graft failure over time.
DALK is the preferred technique for advanced keratoconus where the endothelium is healthy. PK is used for conditions involving all corneal layers, including severe corneal scarring from infection or trauma, failed previous corneal grafts, and certain corneal dystrophies. Your ophthalmologist will recommend the most appropriate technique based on your individual condition.
In keratoconus, the endothelial cells are typically healthy and only the anterior stroma is structurally abnormal. DALK replaces the diseased tissue while preserving the patient’s own endothelium, which means graft rejection of the endothelium is impossible. This significantly reduces the long-term risk of graft failure compared to PK, where the donor endothelium is at ongoing risk of rejection.
The big bubble technique is the preferred surgical method for DALK. Air is injected into the corneal stroma to separate the anterior stroma from Descemet’s membrane, creating a large bubble that allows the anterior tissue to be removed cleanly right down to the membrane. This produces the thinnest possible lamellar interface and the best visual outcomes. If the bubble does not form, a manual dissection technique is used instead.
Visual recovery after penetrating keratoplasty is significantly longer than for partial-thickness techniques. Sutures remain in place for 12–18 months and are removed in a staged fashion. Full visual stabilisation, including finalisation of glasses or contact lens prescription, can take 18–24 months. Long-term steroid drops are required to minimise rejection risk.
DALK recovery is faster than PK, though slower than endothelial keratoplasty. Sutures typically remain for 12 months. Vision improves progressively over 6–12 months following suture removal. Glasses or rigid contact lenses are usually required to achieve the best corrected vision.
The classic symptoms of corneal graft rejection are the four Rs: Redness, Reduced vision, photophobia (sensitivity to light), and pain. Any sudden onset of these symptoms following a corneal transplant should be treated as an emergency. Contact Outlook Eye Specialists or present to your nearest emergency eye service immediately. Prompt treatment with intensive steroid drops can usually reverse the rejection episode.
Yes, though cataract surgery after a corneal transplant requires careful planning to minimise the risk of damaging the graft. Biometry calculations are more complex after corneal transplantation and a slightly different surgical approach is used to protect the endothelium. Your ophthalmologist will discuss the most appropriate timing and technique.
Both penetrating keratoplasty and DALK attract a Medicare rebate for the surgical procedure and the ophthalmologist’s fee. Hospital and anaesthetic fees apply. Our team will provide a full cost breakdown at your pre-operative consultation.