We Pursue Eye Research
Corneal Transplants
Anterior Lamellar Keratoplasty (ALK)
ALK selectively replaces the front part of the cornea when it is scarred or distorted. The cornea is about the thickness of a credit card. In ALK, the surgeon dissects the cornea into two thin pieces and removes the front, scarred part. A matching area of healthy tissue from a donor cornea is then used to replace the area that was removed (Figure 1). This procedure is less invasive than a full thickness graft. Your eye will be stronger after surgery and you will be able to resume normal activities sooner. Also, you have much less risk of rejecting the graft with an ALK. Depending on the type of ALK, sutures may or may not be needed.
Best vision is obtained with a type of ALK known as deep lamellar endothelial keratoplasty (DALK), in which the surgeon only leaves behind 5% or less of your original corneal thickness and replaces the rest with donor tissue (Figure 2). DALK surgery can be done with a manual or hand dissection of donor tissue or by using air to detach the inner layer of your cornea with a technique called the “big bubble”. Dr. Anwar of Saudi Arabia developed the big bubble technique and it has since been adopted around the world. We have found that using a femtosecond laser to make the incisions can facilitate the DALK technique. DALK is our treatment of choice for keratoconus or corneal scars, as long as the inner cell layer of the cornea (the endothelium) is healthy.
The DALK procedure has a higher degree of difficulty than ALK but it provides the best visual results. Dr. Price teaches courses on ALK and DALK techniques.
Publications
- Price FW, Price MO, Grandin JC Kwon R. Deep anterior lamellar keratoplasty with femtosecond-laser zigzag incisions. Journal of Cataract and Refractive Surgery 2009;35:804-808.
- Price FW. Using a “Small bubble technique” helps “big bubble technique”. British Journal of Ophthalmology, 2007; 91:1260-1
