Corneal transplantation is a major surgery which is performed in an operating room. Lamellar keratoplasty is a less invasive form of corneal transplantation which leaves the inner layer of the cornea (corneal endothelium) intact. This is beneficial as this layer is often healthy in those with keratoconus and this procedure has a reduced risk of rejection versus the traditional full thickness corneal transplantation (penetrating keratoplasty).

Deep Anterior Lamellar Keratoplasty (DALK) involves a transplant of all but the inner two layers of the cornea. This involves a surgeon using surgical instruments to precisely prepare the outer portions of the cornea, leaving the inner layers intact. A specially prepared donor cornea with only the outer corneal layers intact (epithelium and stroma) is then placed and secured with sutures. The benefits of this procedure are that the wound heals faster, allowing sutures to be removed sooner. There is also a lower risk of corneal rejection. Complications include irregular astigmatism and scarring at the interface between the patient's cornea and donor cornea. Glasses or contact lenses will still be needed after surgery for functional vision. Because it is a medically necessary treatment, a corneal transplant is generally covered in part by medical insurance.

A variant of this procedure is Femtosecond-Assisted Lamellar Keratoplaty (FALK). In this procedure, a laser is used to prepare the patient's cornea as well as the donor cornea.


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