Also known as Anwar Big bubble technique, deep anterior lamellar Keratoplasty (DALK) is a surgical procedure that replaces the cornea while preserving the thin posterior membrane.
It is an alternative to full thickness Penetrating Keratoplasty (PKP) and is indicated for management of advanced keratoconus, corneal scarring, post LASIK ectasia, endothelium sparring corneal dystrophies and degenerations.
The advantages of DALK include reduced rejection rate, reduced risk of late endothelial cell failure, quicker stabilization of the wound and earlier return to unrestricted physical activity. A shorter course of topical steroids (anti rejection drops) after DALK means faster healing and less risk for steroid induced glaucoma and cataracts.
If the thin posterior membrane ruptures during the surgery, the procedure is converted to a full thickness transplant (penetrating keratoplasty)