Excimer Laser-assisted Deep Anterior Lamellar Keratoplasty (Excimer-DALK)

Abstract: Deep anterior lamellar keratoplasty (DALK) allows selective removal of pathologically altered corneal layers. At our clinic, it is performed according to the Homburg concept as a non-mechanical, contact-free excimer laser-assisted DALK (Excimer-DALK). After early postoperative treatment, DALK gives faster visual rehabilitation. After complete suture removal, visual outcomes are comparable to those of penetrating keratoplasty (PKP), while endothelial cell density remains significantly higher in the long term. Advantages of DALK include improved graft survival, a markedly lower rate of irreversible endothelial immune reactions, and a reduced risk of postoperative intraocular pressure fluctuations. Optimal results require an intact endothelium and complete exposure of Descemet's membrane. Excimer-DALK is therefore a standardised, safe, and particularly attractive alternative to PKP for young patients with keratoconus.