**16. DALK**

Anterior lamellar keratoplasty [66] in the pretext of acute hydrops is a difficult and complex procedure. Susan et al. recommended a modified DALK method for the treatment of acute hydrops. Small aliquots of air are injected into the stroma, immediately above the predescemeticdua layer and away from the site of the descemet rupture. Subsequently, a lamellar dissection with the help of a blunt crescent is performed carefully in the peripheral cornea, while avoiding the site of the DM tear initially, and then dissected at the center by slowly peeling the stroma. A donor cornea of the same size or 0.25 mm oversize is placed over the raw recipient corneal surface and anchored with the help of twelve or sixteen 10–0 nylon sutures. This averts the two-step procedure, which is normally adopted for acute hydrops, and thus, the visual rehabilitation is gained with a single procedure. However, because of edematous cornea, the risk of augmentation of the DM tear is increased and locating a correct plane for dissection becomes difficult for the surgeons. Therefore, surgeons are advised to become well-versed with anterior lamellar keratoplasty before advocating this procedure.
