Abstract
Advanced keratectasia often requires corneal transplantation for restoration of vision. This review discusses the surgical approach suitable for these cases including significant updates in the current literature. With greater understanding of ectatic corneal disease and its associated operative challenges, several modifications in the surgical approach have been developed. Identified predictive factors for successful pneumatic dissection and intraoperative complications have informed surgical planning and decision-making. In the setting of failed pneumatic dissection, sequential use of alternative lamellar dissection techniques is a reasonable surgical strategy. Surgical refinements to optimize visual outcomes and postoperative interventions to correct residual refractive errors have improved visual rehabilitation after keratoplasty. With evidence of its undisputed advantages, DALK has been widely recognized as the primary surgical option for ectatic corneal disease.
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