# Repeated deep anterior lamellar keratoplasty combined with phacoemulsification

## TL;DR

This paper reports a successful vision restoration case using repeated deep anterior lamellar keratoplasty combined with cataract surgery.

## Contribution

Demonstrates successful visual outcome after repeated DALK combined with phacoemulsification in a patient with prior graft failure.

## Key findings

- A patient achieved 6/10 corrected distance visual acuity after repeated DALK and cataract surgery.
- Combining DALK with phacoemulsification may improve outcomes in patients with coexisting cataracts.
- Preserving the patient's own endothelium after an initial graft failure led to successful long-term graft survival.

## Abstract

To report the clinical findings and results of a patient who underwent deep anterior lamellar keratoplasty (DALK) combined with phacoemulsification.

Retrospective analysis of a case that underwent unsuccessful DALK surgery with no visual gain due to striations on the posterior surface of the donor, permanent interface irregularity, and scarring.

Two years after the first DALK surgery, a repeated DALK was performed in combination with phacoemulsification of the cataract that developed during this period. The graft was clear with no signs of rejection or endothelial decompensation, and corrected distance visual acuity was 6/10 in the postoperative last visit, one year after the surgery.

Combining the DALK technique with phacoemulsification in patients with coexisting cataracts may help to achieve a good visual outcome and long-term graft survival. Even after an unsuccessful DALK experience, insisting on preserving the patient’s own endothelium resulted in successful vision restoration with no imposition of further risks for graft survival.