{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:04:36Z","timestamp":1781327076355,"version":"3.54.1"},"reference-count":30,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["ajo.com","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Ophthalmology"],"published-print":{"date-parts":[[2020,12]]},"DOI":"10.1016\/j.ajo.2020.07.009","type":"journal-article","created":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T01:57:06Z","timestamp":1594864626000},"page":"9-18","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":28,"special_numbering":"C","title":["Five-year Outcomes of Converted Mushroom Keratoplasty from Intended Deep Anterior Lamellar Keratoplasty (DALK) Mandate 9-mm Diameter DALK as the Optimal Approach to Keratoconus"],"prefix":"10.1016","volume":"220","author":[{"given":"James","family":"Myerscough","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeli Christy","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4222-7599","authenticated-orcid":false,"given":"Mohamed","family":"Elkadim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Bovone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3635-3521","authenticated-orcid":false,"given":"Massimo","family":"Busin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajo.2020.07.009_bib1","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0886-3350(01)01181-6","article-title":"Big-bubble technique to bare Descemet\u2019s membrane in anterior lamellar keratoplasty","volume":"28","author":"Anwar","year":"2002","journal-title":"J Cataract Refract Surg"},{"key":"10.1016\/j.ajo.2020.07.009_bib2","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1136\/bjo.83.3.327","article-title":"A new surgical technique for deep stromal, anterior lamellar keratoplasty","volume":"83","author":"Melles","year":"1999","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib3","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1097\/ICO.0000000000001223","article-title":"Immunologic rejection episodes after deep anterior lamellar keratoplasty: incidence and risk factors","volume":"36","author":"Gonzalez","year":"2017","journal-title":"Cornea"},{"key":"10.1016\/j.ajo.2020.07.009_bib4","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0161-6420(03)00659-6","article-title":"Impact of graft diameter on corneal power and the regularity of postkeratoplasty astigmatism before and after suture removal","volume":"110","author":"Seitz","year":"2003","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ajo.2020.07.009_bib5","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1136\/bjophthalmol-2014-306170","article-title":"Large-diameter deep anterior lamellar keratoplasty for keratoconus: visual and refractive outcomes","volume":"99","author":"Huang","year":"2015","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib6","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ajo.2019.01.022","article-title":"Deep anterior lamellar keratoplasty for keratoconus: multisurgeon results","volume":"201","author":"Gadhvi","year":"2019","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib7","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1097\/TP.0b013e3181903b0a","article-title":"Risk factors for human corneal graft failure within the Australian corneal graft registry","volume":"86","author":"Williams","year":"2008","journal-title":"Transplantation"},{"key":"10.1016\/j.ajo.2020.07.009_bib8","first-page":"T1","article-title":"A two-piece microkeratome-assisted mushroom keratoplasty improves the outcomes and survival of grafts performed in eyes with diseased stroma and healthy endothelium (An American Ophthalmological Society Thesis)","volume":"113","author":"Busin","year":"2015","journal-title":"Trans Am Ophthalmol Soc"},{"key":"10.1016\/j.ajo.2020.07.009_bib9","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.oftal.2014.11.008","article-title":"Comparative study of keratoconus between Anwar's deep anterior lamellar keratoplasty versus converted penetrating keratoplasty","volume":"90","author":"Donoso","year":"2015","journal-title":"Arch Soc Esp de Oftalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib10","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.ophtha.2017.02.011","article-title":"Large (9\u00a0mm) deep anterior lamellar keratoplasty with clearance of a 6-mm optical zone optimizes outcomes of keratoconus surgery","volume":"124","author":"Busin","year":"2017","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ajo.2020.07.009_bib11","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/ICO.0000000000002067","article-title":"Peripheral intrastromal hydration facilitates safe, deep trephination in corneas of irregular thickness","volume":"39","author":"Bovone","year":"2020","journal-title":"Cornea"},{"key":"10.1016\/j.ajo.2020.07.009_bib12","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ajo.2019.03.026","article-title":"Factors predictive of double anterior chamber formation following deep anterior lamellar keratoplasty","volume":"205","author":"Myerscough","year":"2019","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib13","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1097\/ICO.0000000000001584","article-title":"Immunologic stromal rejection after deep anterior lamellar keratoplasty with grafts of a larger size (9\u00a0mm) for various stromal diseases","volume":"37","author":"Giannaccare","year":"2018","journal-title":"Cornea"},{"key":"10.1016\/j.ajo.2020.07.009_bib14","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1136\/bjophthalmol-2015-307111","article-title":"Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus","volume":"100","author":"Feizi","year":"2016","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib15","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ajo.2018.10.026","article-title":"Incidence and outcomes of intraoperative Descemet membrane perforations during deep anterior lamellar keratoplasty","volume":"199","author":"Huang","year":"2019","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib16","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.4103\/ijo.IJO_282_18","article-title":"Outcome of deep anterior lamellar keratoplasty patients with intraoperative Descemet's membrane perforation: a retrospective cross-sectional study","volume":"66","author":"Kodavoor","year":"2018","journal-title":"Indian J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib17","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1136\/bjophthalmol-2019-314352","article-title":"Evaluation of the risk factors associated with conversion of intended deep anterior lamellar keratoplasty to penetrating keratoplasty","volume":"104","author":"Myerscough","year":"2020","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib18","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ajo.2015.04.006","article-title":"Changes in keratocyte density and visual function five years after laser in\u00a0situ keratomileusis: femtosecond laser vs. mechanical microkeratome","volume":"160","author":"McLaren","year":"2016","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib19","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1016\/j.ophtha.2012.11.030","article-title":"Ultrathin Descemet\u2019s stripping automated endothelial keratoplasty with the microkeratome double-pass technique: two-year outcomes","volume":"120","author":"Busin","year":"2013","journal-title":"Ophthalmology"},{"key":"10.1016\/j.ajo.2020.07.009_bib20","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1136\/bjophthalmol-2018-313509","article-title":"Comparison of corneal densitometry between big-bubble and visco-bubble deep anterior lamellar keratoplasty","volume":"104","author":"Scorcia","year":"2020","journal-title":"Br J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib21","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/ICO.0000000000000691","article-title":"Deep anterior lamellar keratoplasty versus penetrating keratoplasty: a meta-analysis of randomized controlled trials","volume":"35","author":"Chen","year":"2016","journal-title":"Cornea"},{"key":"10.1016\/j.ajo.2020.07.009_bib22","first-page":"928","article-title":"Movement of corneal endothelium after penetrating keratoplasty. Observation of sex chromatin as a cell marker","volume":"94","author":"Imaizumi","year":"1990","journal-title":"Nippon Ganka Gakkai Zasshi"},{"key":"10.1016\/j.ajo.2020.07.009_bib23","first-page":"CD009700","article-title":"Deep anterior lamellar keratoplasty versus penetrating keratoplasty for treating keratoconus","author":"Keane","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajo.2020.07.009_bib24","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.clae.2016.10.001","article-title":"Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus","volume":"40","author":"Henein","year":"2017","journal-title":"Contact Lens Anterior Eye"},{"key":"10.1016\/j.ajo.2020.07.009_bib25","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.ajo.2020.04.016","article-title":"Initial high-dose prophylaxis and extended taper for mushroom keratoplasty in vascularized herpetic scars","volume":"217","author":"Yu","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib26","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1097\/ICO.0000000000000915","article-title":"Treatment of Fuchs endothelial dystrophy by Descemet stripping without endothelial keratoplasty","volume":"35","author":"Borkar","year":"2016","journal-title":"Cornea"},{"key":"10.1016\/j.ajo.2020.07.009_bib27","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/ICU.0000000000000666","article-title":"Optimizing outcomes for keratoplasty in ectatic corneal disease","volume":"31","author":"Yu","year":"2020","journal-title":"Curr Opin Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib28","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1038\/s41433-019-0686-6","article-title":"A novel blunt dissection technique to treat modified deep anterior lamellar keratoplasty (DALK)-associated high astigmatism","volume":"34","author":"Elkadim","year":"2020","journal-title":"Eye (Lond)"},{"key":"10.1016\/j.ajo.2020.07.009_bib29","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.ajo.2008.08.001","article-title":"Long-term keratometric changes after penetrating keratoplasty for keratoconus and Fuchs endothelial dystrophy","volume":"147","author":"Raecker","year":"2009","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.ajo.2020.07.009_bib30","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/bjo.2008.142117","article-title":"Recurrent ectasia in corneal grafts and outcomes of repeat keratoplasty for keratoconus","volume":"93","author":"Patel","year":"2009","journal-title":"Br J Ophthalmol"}],"container-title":["American Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002939420303603?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002939420303603?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T13:43:11Z","timestamp":1757598191000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0002939420303603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":30,"alternative-id":["S0002939420303603"],"URL":"https:\/\/doi.org\/10.1016\/j.ajo.2020.07.009","relation":{},"ISSN":["0002-9394"],"issn-type":[{"value":"0002-9394","type":"print"}],"subject":[],"published":{"date-parts":[[2020,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Five-year Outcomes of Converted Mushroom Keratoplasty from Intended Deep Anterior Lamellar Keratoplasty (DALK) Mandate 9-mm Diameter DALK as the Optimal Approach to Keratoconus","name":"articletitle","label":"Article Title"},{"value":"American Journal of Ophthalmology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajo.2020.07.009","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}