Surgical Outcomes of Different Deep Anterior Lamellar Keratoplasty Techniques-A Single-Centre UK Study

Background: Anterior lamellar keratoplasty (ALK) is a less invasive procedure than PK, and thus avoids many of the intraocular complications associated with PK. DALK can be performed using several different techniques, with either a manual dissection, a keratome or femtosecond-laser assisted dissection, or with a big bubble technique. To analyse the outcomes and compare the results of three deep anterior lamellar keratoplasty (DALK) techniques. Methods: This study included 105 DALK cases performed at Queen Victoria Hospital, East Grinstead, UK, in the period between January 2016 and May 2022. Cases were classified into four groups based on technique: BB-DALK, manual DALK, FS-DALK and 'converted to PK group'. Results: There was significant improvement in VA and Kmax compared to the preoperative values in all groups. There was no significant difference detected in VA and Kmax between all groups. Conclusions: Performing DALK surgery with any suitable technique (manual, big-bubble or femtosecond-assisted) is effective and causes significant improvements in VA and Kmax, even in cases where a conversion to penetrating keratoplasty is required. However, every technique has its pros and cons and should be tailored according to surgeon preference and individual case pathology.