Mitomycin C -Peel-Off Dalk: A Novel Technique

To present a novel modification to the Peeling-off DALK technique originally described by Malbran et al. in 1966, that manually separates the anterior corneal stroma. This modification incorporates the application of 0.04% Mitomycin C (MMC) application to the descemet membrane and residual stromal bed, aiming to enhance postoperative visual recovery.

Barzilai Medecal Center, Israel. 

A retrospective series of DALK cases utilizing the MMC-Peeling-off technique from January 2018 and January 2023, and followed for at least 1 year were reviewed. We evaluated the indications for DALK, postoperative best-corrected visual acuity (BCVA), complications, and endothelial cell count across subsequent visits.

DALK with the MMC-Peeling-off method was performed on 18 eyes from 16 patients.  Indications included keratoconus (12 eyes) and stromal scarring (6 eyes). The application of MMC aimed to prevent haze formation in manual DALK. Only one eye developed pot-operative corneal haze. Postoperatively, no significant difference in endothelial cell count was observed between the first and last visits (2441.89 ± 281.6 vs. 2587 ± 165.39, P=0.7), and no MMC post-operative complications were recorded. Postoperative Optical coherence tomography OCT showed normal retinal nerve fiber layer (RNFL) in all patients.

Incorporating MMC into the recipient bed during manual Peeling-off DALK demonstrates promise for optimizing visual outcomes while preserving endothelial cell count and avoiding postoperative complications.