Deep Anterior Lamellar
Keratoplasty (DALK) Surgery

What is DALK Surgery?

Deep Anterior Lamellar Keratoplasty also referred to as DALK eye surgery is a corneal transplantation for Keratoconus, stromal dystrophies and scars. There are approximately 1500 DALK corneal surgeries completed across Sydney and Australia annually, with at least 300 of these for Keratoconus.

Patients in Sydney suffering from eye diseases such as Keratoconus can visit our Vision Clinic Sydney practice to learn more about DALK Surgery as a potential treatment option.

DALK surgery is used to replace the outermost layers of the cornea while preserving the well-functioning inner layers known as Descemet’s membrane and the endothelium.

It is a more complex surgery than traditional full-thickness corneal transplantation (also called Penetrating Keratoplasty, or PK) and is typically only performed by surgeons who have undergone specialised training.

DALK may be indicated in cases where the back layer of the cornea is healthy, but the front and middle layers are diseased.

It may therefore be a better option than a penetrating keratoplasty, in which the full thickness of the entire cornea must be removed. The full-thickness traditional method is more invasive and can place the patient at higher risk for developing healing or vision problems.

Appropriate procedure

This procedure is appropriate for those patients with damage restricted to the outer layers of the cornea, such as Keratoconus. Several layers of corneal tissue are removed from the patient’s eye and replaced with the corresponding tissue from a donor’s eye.

Since more natural tissue is maintained in a DALK procedure, graft rejection is less likely than penetrating keratoplasty.

Indications for Deep Anterior Lamellar Keratoplasty

DALK may be indicated in cases of corneal diseases affecting the front and middle layers of the cornea, such as:

Keratoconus
Corneal scarring
Anterior corneal dystrophies

How DALK Surgery works

Preoperative Evaluation for Deep Anterior Lamellar Keratoplasty

Prior to DALK surgery, the patient will undergo a comprehensive eye examination. This will include testing of visual acuity, refraction, corneal thickness and topography. The surgeon will also evaluate the health of the front and back layers of the cornea using a microscope.

In some cases, additional tests may be required prior to surgery. This may include:

Corneal mapping (also called Pentacam topography and tomography): This test uses a camera to create a three-dimensional map of the cornea. It can help to assess the thickness of the cornea and to identify areas of thinning.
Corneal tomography (also called OCT or anterior segment OCT): This test uses optical coherence tomography to create a cross-sectional image of the cornea. It can help to assess the thickness of the cornea and to identify areas of abnormalities.

After the preoperative evaluation, the surgeon will determine if the patient is a good candidate for DALK surgery. If the patient is not a good candidate, another type of surgery may be recommended.

DALK surgery is a complex procedure that is not suitable for all patients. The surgeon will carefully consider the results of the preoperative evaluation to determine if DALK surgery is the best option for the patient.

Surgical Technique for Deep Anterior Lamellar Keratoplasty

DALK surgery is typically performed under local anaesthesia. The surgeon will make an incision in the cornea and then gently peel away the cornea’s diseased front and middle layers, leaving the healthy back layer intact.

The surgeon will then replace the diseased tissue with a donor cornea. Finally, the incision will be closed with sutures.

The surgery typically takes 1-2 hours to complete. After surgery, the patient will be monitored for complications and prescribed medication to help reduce inflammation and pain.

Postoperative Management after Deep Anterior Lamellar Keratoplasty

After DALK surgery, it is important for the patient to follow all instructions from their surgeon. This typically includes using eye drops as prescribed and avoiding rubbing or touching the eye. In addition, the patient should avoid activities that may put undue stress on the eye, such as swimming or contact sports.

Most patients need to wear an eye patch for the first few days after surgery. The eye will also be covered with a protective shield at night. Sutures will be removed 1-2 months after surgery.

Most patients will experience some degree of discomfort and light sensitivity immediately after surgery. These symptoms typically resolve within a few days. Visual acuity will improve gradually over the course of several months.

It is essential to keep all follow-up appointments with the surgeon to ensure that the eye is healing properly. The surgeon will also monitor for any signs of complications, such as infection or rejection of the transplanted tissue.

Complications of Deep
Anterior Lamellar Keratoplasty

Complications from DALK surgery are relatively rare but can occur, which include:

Corneal rejection: The body may reject the transplanted tissue. This can occur if the patient does not take their immunosuppressive medication as prescribed. Symptoms of rejection include pain, redness and decreased vision. Rejection typically occurs within the first 3 months after surgery.
Infection: An infection can occur at the site of the incision or within the eye. Symptoms of infection include pain, redness and decreased vision. Infections typically occur within the first month after surgery.
Glaucoma: Glaucoma is increased pressure within the eye. It can occur if the incision is not properly sealed or if there is blockage of the drainage channels within the eye. Symptoms of glaucoma include headache, eye pain and decreased vision. Glaucoma typically occurs within the first few months after surgery.
Cataract: A cataract is a clouding of the lens of the eye. It can occur if inflammation from the surgery spreads to the lens of the eye. Symptoms of a cataract include blurred vision and increased sensitivity to light. A cataract typically develops months to years after surgery.

If you experience any of these symptoms after DALK surgery, it is important to contact your surgeon immediately.

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Recovery from DALK

The surgery involves more corneal layers and tends to need more steroid drops which can delay healing.
DALK transplants are usually fully healed with visual recovery within 6 to 8 months when it is safe to remove all sutures.

How Can Vision Clinic Sydney Help You with DALK Surgery

Meet our doctor

In 1998 Dr Nikhil Kumar graduated in Medicine from the University of Newcastle and completed ophthalmology speciality training in 2008 at the Sydney Eye Hospital. He followed this with fellowship training in Cornea surgery for keratoconus and laser correction at the University of Toronto in 2009.

He is committed to the preservation and improvement of the quality of vision and is dedicated to maintaining the highest standard of ophthalmic medical and surgical care.

Our location in Sydney

We are located in the central business district of Sydney in New South Wales. Our physical address is Level 6, Suite 605, 229 Macquarie St., Sydney NSW 2000, Australia.

Costs of DALK Surgery in Sydney

We advise booking an initial consultation with us to get an accurate estimate of how much the surgery will cost you. We also provide flexible payment plans for any surgical procedures at Vision Clinic Sydney. Please visit Medipay for more information and how to apply.

Frequently Asked Questions

Is DALK a type of thickness corneal transplantation?

DALK is a partial-thickness corneal transplant surgery that involves only the donor stroma, leaving the recipient’s own Descemet’s membrane and endothelium.

Is DALK surgery able to cure corneal disease?

DALK surgery is most successful in curing corneal disease and will work without complications for up to 10 years, but as is the case with all transplants, there is a risk of infection and rejection.

Is DALK surgery a safe procedure?

DALK surgery is considered a safe and effective technique for patients requiring corneal transplantation.

How to schedule a consultation

For your first appointment, you will need a referral letter from your General Practitioner or Optometrist. You can still be seen at the practice without a referral but will not be able to claim a Medicare rebate for the consultation or any tests/procedures you may have performed at the clinic. You can download the referral PDF form or submit it online.

Please call us if you need any more information on how to book a consultation at +61 2 9222 9188.

Deep Anterior Lamellar
Keratoplasty (DALK) Surgery