Mitomycin C Assisted Manual Deep Anterior Lamellar Keratoplasty (M-Dalk): A Novel Technique.

To present a novel modification to the manual deep anterior lamellar keratoplasty (DALK) technique that manually separates the anterior corneal stroma. This modification incorporates 0.04% Mitomycin C (MMC) application to the residual stromal bed, enhancing postoperative visual recovery and reducing interface haze.

Barzilai Medical Center

We reviewed a retrospective series of DALK cases utilizing the MMC-manual Dalk (M-DALK) technique from May 2019 to May 2022. The technique involves creating a deep stromal track using a blunt spatula and corneal scissors, peeling off the central stroma, and applying 0.02% Mitomycin C (MMC) for 20 seconds to the recipient bed to enhance outcomes. We evaluated the indications for DALK, postoperative best-corrected visual acuity (BCVA), complications, optical coherence tomography (OCT) of the macular and the retinal nerve fiber layer (RNFL), and endothelial cell count across subsequent visits.

M-DALK was performed on 18 eyes of 16 patients. The application of MMC was aimed to prevent haze formation in manual DALK. All grafts remained clear without haze development through the follow-up period (up to 55 months). No MMC-associated post-operative complications were recorded. Endothelial cell counts remained normal at the final follow-up, averaging 2637.6 ± 89.12 cells/mm². Postoperative Optical coherence tomography (OCT) showed normal retinal nerve fiber layer (RNFL) and macula in all patients.

Applying MMC to the recipient bed during manual DALK demonstrates promise for optimizing visual outcomes while preventing interface haze and avoiding postoperative complications.