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Case series of staged lamellar corneal grafting with thin manual Descemet’s stripping endothelial keratoplasty, followed by manual deep anterior lamellar keratoplasty, as an alternative to penetrating keratoplasty
  1. Abdo Karim Tourkmani1,
  2. Eleanor McCance1,
  3. Abdus Samad Ansari1 and
  4. David F Anderson2
  1. 1Royal Gwent Hospital, Newport, Wales, UK
  2. 2University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Abdo Karim Tourkmani; Karim.Tourkmani2{at}


The purpose of this report is to present the outcomes of Descemet’s stripping endothelial keratoplasty (DSEK), followed by deep anterior lamellar keratoplasty (DALK), as an alternative to penetrating keratoplasty (PKP) for different indications. Patients in this retrospective case series underwent manual DSEK, followed by manual DALK, for tectonic and/or visual reasons. It includes three cases that underwent DSEK followed by DALK as an alternative to PKP for the following conditions: failed PKP and stromal scarring, aphakic bullous keratopathy and herpetic stromal scarring, and herpetic corneal perforation. All cases had successful anatomical repair with visual improvement. Many corneal conditions involving endothelium and stroma have been traditionally managed with PKP. However, in certain settings with high risk of complications, this might not be an appropriate option. Therefore, for these cases, we propose management with DSEK followed by DALK as an alternative approach in a ‘closed anterior chamber’ fashion, which can reduce the risk of significant, sometimes irreversible, complications.

  • Ophthalmology
  • Anterior chamber

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  • Contributors AKT was the main surgeon performing all surgeries described in this paper. AKT, EM, ASA and DA were involved in data collection and analysis, drafting and reviewing manuscript for submission.

  • Funding This study was funded by Aneurin Bevan Health Board (Fellowship Code SF0158134).

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.