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J. J. Bonkowske, M. Giegengack; DALK: A Surgeon's Initial Experience and Learning Curve. Invest. Ophthalmol. Vis. Sci. 2009;50(13):612.
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DALK, or Deep Anterior Lamellar Keratoplasty, is a surgical technique that provides a means to replace the anterior layers of the cornea, while keeping the patient’s endothelium and Descemet’s membrane intact. DALK can be used as an alternative to penetrating keratoplasty (the gold standard) for diseases of the anterior cornea, where the patient’s endothelium and Descemet’s membrane are not affected.
Charts were retrospectively reviewed regarding a surgeon’s first four DALK surgeries, performed with a surgical method based on Anwar’s "big bubble technique". Information was collected regarding pre- and post-operative visual acuity, pre- and post-operative refraction, safety measures, surgical complications, conversion to penetrating keratoplasty, infection rates, corneal clarity, and pre- and post-operative intraocular pressures.
Outcome measures are reported including: patient safety, surgical complications, rate of conversion to penetrating keratoplasty, infection rates, corneal clarity, visual acuity, and intraocular pressure based on the first four DALK surgeries performed.
Here we present our initial findings and outcomes for our sentinel cases for a novice DALK surgeon performing his first 4 cases. This demonstrates the learning curve that applies for a surgeon as they begin to perform new and more technically difficult surgical cases.
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