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Welcome to Cornea Colours, aiming to simplify complex corneal surgeries with key insights, from basics to advanced techniques. Learn, grow, and excel with us. DALK is a surgical technique to remove the corneal stroma up to Descemet’s membrane, preserving the endothelium. It is ideal for conditions like keratoconus and corneal scarring, offering excellent visual outcomes while reducing graft rejection risks. Procedure Highlights: 1. Host Bed Preparation 1. Trephination: • Fix Fleiringa ring with 6-0 silk sutures. • Use an 8.5 mm trephine for a precise impression, minimizing slippage on ectatic corneas. 2. Trephine Diameter: • Cover the ectatic area guided by the Fleischer ring and topography. 3. Groove Creation: • Use a guarded blade (300 μ depth) for a perpendicular groove. 4. Layer-by-Layer Stroma Dissection: • Dissect anterior stroma (250–300 μ), detaching stromal layers carefully. • Apply BSS to visualize remaining fibers. • Gradually thin the stroma to ~70–80 μ using forceps and crescent knives. 2. Graft Preparation 1. Trephine Size: • Match or exceed host trephine size by 0.25 mm. 2. Punch donor tissue with an 8.5 mm trephine. • Remove Descemet’s membrane with a Merocel sponge. 3. Graft Suturing • Position graft; secure with 10-0 nylon sutures. • Suture depth: 60% in graft, 90% in host due to thickness differences. • Start with 4 primary sutures (12, 6, 3, 9 o’clock), followed by secondary and tertiary sutures. • Massage graft edges to smooth Descemet’s folds. • Bury suture knots and assess uniform tension using Maloney’s ring. • Hydrate the cornea with BSS. Disclaimer: This video is meant for the education of eye specialist. The treatment should be done by ophthalmologist based on own clinical judgment.