الفهرس 
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Abstract
Deep anterior lamellar keratoplasty (DALK) is a surgical procedure in which diseased corneal stroma is dissected as far as or close to Descemet membrane (DM) followed by transplantation of the donor corneal button free from DM and endothelium, and can be considered the first surgical choice for various corneal stromal diseases with intact endothelium.
Avoiding full-thickness corneal trephination reduces the risks of intraoperative and postoperative complications of Penetrating keratoplasty (PKP) by the avoidance of an open sky procedure and better preservation of the structural integrity of the globe.
Corneal grafting techniques are affected by many variables, biological, immunological, biomechanical, surgical and technological, which make this procedure intrinsically variable. The variability of the outcomes affects not only the visual and refractive outcomes but also the biological performance of the tissues affected by the graft and by the surgical trauma and, overall, the visual recovery of the patient. The use of femtosecond lasers has improved many of these variables making corneal grafting surgery a better and more controllable technique.
The aim of this study was to show the indications, techniques and complications of deep Anterior lamellar keratoplasty and to compare the results of manual and femtosecond assisted DALK.
The study was mainly evaluating the two techniques and their effect on healing, visual and refractive outcomes.
Fifty eyes (47 patients) were included in this study and were classified into two groups depending on whether femtosecond assisted or manual DALK technique was performed for the side cut. The first group (femtosecond assisted DALK) included 25 eyes (22 patients) and the second group (manual DALK) included 25 eyes (25 patients). The routine Ophthalmologic examinations were done at 1 month, 6 months and 1 year, in addition to Visante OCT and in vivo confocal microscopy in selected cases from both groups.
This study concluded that the two procedures have comparable visual and refractive outcomes. However, FSL group achieved this improvement faster (mean UCDVA is better at 1 month in the FSL group). The greatest improvement in mean BCDVA occurred at 1 year in both groups, but it was better in the FSL group. FSL- assisted DALK has stronger and more evident side cut corneal wound healing and can be technically easier and safer.