In the pre-operative phase the necessary measurements and examinations are carried out to find out whether the patient is a good candidate for DALK. Checks are made to see if there are other eye disorders such as cataract, macular degeneration, etc. In some circumstances the patient will first have to undergo a cataract operation before being considered for DALK.
This procedure is carried out in an outpatient clinic. The patient is given a sedative and an anaesthetic is injected behind the eye (retrobulbar block). Only the injection causes a little discomfort. The patient is conscious but will feel nothing.
Once the local anaesthetic has taken effect, the patient's eye is covered with sterile cloths. During the first part of the DALK procedure, a very small incision is made at the corneal limbus through which an air bubble is injected into the anterior chamber. Then all the tissue just above Descemet's membrane is removed by dissection. After this dissection, the air bubble is removed from the anterior chamber. The last section of the stroma is split off from Descemet’s membrane using a visco-elastic dissection, whereby some visco-elastic material is introduced into the deeper layers between Descemet’s membrane and the stroma. This prevents any perforation of Descemet’s membrane. After a trepanation (using a round knife) of the front section of the cornea (stroma), a round knife is used to remove the stroma. The donor graft (from a cornea bank) is then inserted in the opening created, and is positioned next to the remaining Descemet’s membrane. The graft is attached to the peripheral cornea tissue of the patient using a running nylon suture.
Once this is done, an antiseptic eye ointment is applied in addition to a pressure bandage. This bandage can be removed the next day by the patient. The whole procedure is carried out in 75 to 90 minutes. The patient is required to take it easy until the next day when the post-operative check-up takes place.
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