Department of Ophthalmology, Apollo Hospitals, Jubilee Hills, Hyderabad, Andhra Pradesh, India.
Indian J Ophthalmol. 2013 Aug;61(8):465-8. doi: 10.4103/0301-4738.116061.
Advanced cases of keratoconus often require surgical intervention to restore corneal anatomy and improve eyesight. Penetrating keratoplasty (PK) although commonly performed has potential risk of immunological rejection and is now no longer automatically the first choice of surgery. DALK procedures have evolved, which allows surgical replacement of recipient's corneal stroma, leaving behind healthy descemet membrane (DM) and endothelium. This reduces the risk of allograft endothelial rejection and late graft failure. In recent times, DALK techniques have led to significant improvements in visual outcome and current results are comparable to PK. Big bubble technique of DALK has become the most popular among the various surgical techniques described. Manual near DM DALK also gives good outcome although the visual recovery is often delayed. Future integration of femtosecond laser technology along with diagnostic imaging technology is likely to further improve outcomes of DALK in keratoconus.
圆锥角膜的晚期病例常需要手术干预来恢复角膜解剖结构和改善视力。穿透性角膜移植术（PK）虽然常被施行，但存在免疫排斥的潜在风险，现已不再是手术的首选。现在已经发展出了深板层角膜移植术（DALK），可以手术替换受体的角膜基质，保留健康的后弹力层（DM）和内皮。这降低了同种异体移植物内皮排斥和晚期移植物失功的风险。最近，DALK 技术使视力结果显著改善，目前的结果可与 PK 相媲美。DALK 的大泡技术在各种描述的手术技术中最为流行。尽管视力恢复通常延迟，但手动近 DM DALK 也能获得良好的结果。飞秒激光技术与诊断成像技术的未来整合可能会进一步改善圆锥角膜的 DALK 结果。
