Deep anterior lamellar keratoplasty is a partial thickness graft that preserves the TWO inner most layers of the cornea: Descemet's membrane and the endothelium. The goal of the procedure is to retain the endothelial layer of the host. This layer keeps the cornea clear by removing fluid from the bulk of the cornea. Retaining this layer avoids the risk of potentially blinding Graft Rejection that can occur with Penetrating Keratoplasty. If the endothelial layer is normal, then it is worth preserving.

The procedure is technically skilled and involves dissecting the cornea to almost 95% thickness, and removing the top layer. A donor corneal button is prepared by removing Descemet's membrane and donor endothelium. The donor graft is then sutured to the host. The cornea takes a little longer to clear but visual results can be similar to those of a penetrating keratoplasty.

Advantages

		Closed eye surgery
		No chance of blinding Endothelial rejection (by retaining the recipient's own endothelial layer)
		Can always perform a Penetrating Keratoplasty if visual results are not satisfactory

Disadvantages

		Technically challenging
		Potential for interface scarring (and reduced visual clarity)