Eyeworld

EW MEETING REPORTER 142 October 2016 Reporting from the 2016 ESCRS Congress, September 10–14, Copenhagen, Denmark Reporting from the ESCRS Congress Tips for a successful DALK procedure Deep anterior lamellar keratoplasty (DALK) was a highlighted topic at the 7th EuCornea Congress. Edward Holland, MD, Cincin- nati, compared DALK and penetrat- ing keratoplasty (PK), noting that, at least in the U.S., more PKs are still being performed despite their higher risk for intraocular complications, astigmatism, unpredictable corneal power, delayed visual rehabilitation, rupture, endothelial rejection, and endothelial cell loss. DALK, however, presents several advantages over PK. It retains the host endothelium, eliminating the risk of rejection and reducing endothelial cell loss. It also has fewer intraocular complications and a stronger corneal wound with less astigmatism. DALK is technically more diffi- cult, requires a longer surgical time, and visual outcomes are not as good as PK with the potential for interface haze. Postoperative complications include suture-related issues, rejec- tion of subepithelial or stromal tis- sue, endothelial cell loss, and double anterior chamber. "We think the data is certainly very strong for physicians to look at DALK as a procedure for stromal disease," Dr. Holland said, noting that many are still performing the more established PK, despite its cons outweighing the pros when com- pared to DALK. Rudy Nuijts, MD, Maastricht, Netherlands, gave several DALK tips based on his own surgical technique. First, Dr. Nuijts recommended that surgeons practice DALK, which has a learning curve, in a wet lab setting. He also said general anesthesia might be recommended for DALK over local anesthesia because it al- lows the surgeon to prevent inadver- tent patient movement and handle unexpected situations that might come with a longer procedure time. Next, he said thickness mea- surements with optical coherence tomography (OCT) or Pentacam (Oculus, Arlington, Washington) of

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