DALK: Post operative management

Abstract

SummarySuccess of DALK, like that of any other operation depends on good surgical technique, appropriate post‐operative examination, treatment, early detection of any problems and adequate management thereof.In the immediate post operative period eye pressure check is important especially if air is left in the anterior chamber. High pressure can cause Urrets‐Zavalia syndrome if not treated.Topical steroids, antibiotics, mydriatic and hypotensive medication if needed, are the mainstay postoperatively. Steroids can be tapered and discontinued earlier than for PK as there is no risk of endothelial rejection.In the early postoperative days, special attention should be paid to the sutures, epithelial defects, signs of inflammation and infection. A loose suture needs to be removed and replaced as soon as possible as it carried a high risk of infection and vascularization. The latter can be a precursor of stromal rejection. Epithelial rejection does occur and behaves exactly like in PK with an advancing epithelial line that stains with fluorescein.Astigmatism is a major problem, strategies for management include, selective suture removal, glasses, contact lenses, arcuate incisions, laser refractive surgery and toric intraocular implants.