Purpose of review: Recent advances in surgical technique have promoted a paradigm shift in the surgical treatment of corneal disease. Penetrating keratoplasty is now being replaced by various types of lamellar techniques that aim to replace damaged tissue only, while maintaining healthy tissue intact. This review focuses on recent advances in deep anterior lamellar keratoplasty.
Recent findings: The concept of creating a deep lamellar bed for lamellar keratoplasty is not new, but exposing Descemet's membrane was a tedious, time consuming procedure. New techniques that use air and ophthalmic viscosurgical devices to directly expose Descemet's membrane have dramatically reduced surgery time, while improving the safety of performing surgery. The indications for deep anterior lamellar keratoplasty have expanded from keratoconus and hereditary dystrophies, to include severe ocular surface disease and cases following infection and corneal perforation.
Summary: Deep anterior lamellar keratoplasty can be considered as the first choice of surgery for a wide range of corneal disease, with bullous keratopathy as the only absolute contraindication.