Deep Anterior Lamellar Keratoplasty

Preparation of Graft

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This video shows how to prepare a graft for DALK by removing the Descemet’s membrane and trephining to the desired size.


  • Descemet’s membrane
  • endothelium
  • keratoconic eye
  • DALK
  • donor cornea
  • suture
  • blue stain
  • Trypan blue

About this video

Soosan Jacob
First online
12 July 2019
Online ISBN
Springer, Cham
Copyright information
© The Author(s) 2019

Video Transcript

This video shows how to prepare the graft for a deep anterior lamellar keratoplasty. For this, a corneo-scleral graft is taken, and it is punched and then stained with trypan blue. And the Descemet’s membrane can be pulled away.

The other way to do this is first stain with trypan blue, score and remove the Descemet’s membrane across the whole graft, and then go ahead and punch the button. Either way, the endothelium is not going to be used or transplanted into the keratoconic eye. And this donor Descemet’s membrane with the endothelium can be used for a Descemet’s membrane endothelial keratoplasty if required.

Now, the donor cornea is then placed on top of the recipient bed. And then it is sutured into place.

Here’s the alternate way to prepare the graft. I’ve taken a corneo-scleral rim and stained it first with trypan blue. The trypan blue is then washed away, and a Sinskey hook is used to score the Descemet’s membrane close to the limbus.

Once the Descemet’s membrane is scored 360 degrees around, a little bit of fluid or BSS is placed within the donor corneo-scleral rim And the Descemet’s membrane is pulled from the periphery to the center from all sides.

Once it is loose from all sides, it is removed, leaving behind the bare bed. The graft is then placed on the Teflon block, centered. and it is punched to the desired size using a trephine. Different trephines are available for this purpose according to surgeon’s preference.