Deep anterior lamellar keratoplasty in post-laser in situ keratomileusis keratectasia

We describe a technique using deep anterior lamellar keratoplasty (DALK) in 5 eyes that developed keratectasia after LASIK. The technique is based on surgical manipulation that allows visualization of the lamellar dissection depth using a posterior approach to reach the predescemetic space. The mirror effect, indentation effect, and folding effect were used to determine proximity to Descemet's membrane. The same diameter donor and recipient buttons were used to correct myopia. The donor button without Descemet's membrane was placed using 10-0 nylon sutures. No intraoperative or postoperative complications occurred. The mean best spectacle-corrected visual acuity changed from 0.16 diopter (D) ± 0.05 (SD) (range 0.10 to 0.25 D) before DALK to 0.68 ± 0.19 D (range 0.5 to 1.0 D) after DALK. Deep anterior lamellar keratoplasty may be a better alternative than penetrating keratoplasty for any pathology with healthy endothelium.