Mastering DALK by Jacob Soosan;

Author:Jacob, Soosan; [JACOB, SOOSAN]
Language: eng
Format: epub
ISBN: 5762598
Publisher: SLACK, Incorporated

Please see videos on the accompanying website at

www.healio.com/books/DALKvideos

7

The Melles Technique

C. Maya Tong, BSc, MD; Jack Parker, MD, PhD; Korine van Dijk, BOptom, PhD; Rénuka S. Birbal, MD; and Gerrit R. J. Melles, MD, PhD

Deep anterior lamellar keratoplasty (DALK) is designed to exchange healthy donor corneal stroma for recipient pathologic corneal stroma. Unlike its predecessor, penetrating keratoplasty (PK), DALK leaves the recipient Descemet’s membrane (DM) and endothelium intact. Broadly speaking, there are 2 basic, competing, surgical strategies for DALK: those relying on injection and those relying on manual dissection. Melles Manual DALK (MM-DALK) falls into the latter category; it is unique in that, unlike other manual techniques, MM-DALK facilitates precise, reliable dissection down to the level of the DM by use of a phenomenon known as the air-endothelial reflex.1,2

BACKGROUND

Anterior lamellar keratoplasty (ALK) was first developed over 150 years ago.3 Early attempts at the operation, where the recipient cornea was dissected near the DM, were made as early as the 1950s by Hallermann.4 While structurally and technically successful, these early efforts were largely regarded, both optically and functionally, as failures, because the visual results of the early anterior lamellar transplants were often far inferior to those achieved by penetrating grafts.5 The explanation for this underperformance was that total removal of the recipient stroma, down to the DM, was difficult to achieve by the usual means of manual dissection from the corneal surface. The layers of stroma inevitably left behind would interact negatively with the donor tissue, producing haze at the graft interface and spoiling the transplant’s optical performance.6 Therefore, major attempts at ALK were largely abandoned for decades until new methods for more complete recipient stromal removal could be discovered.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.