{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T20:33:40Z","timestamp":1777581220142,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Residual bed thickness in DALK should be less than 80\u03bcm to provide optimal visual outcomes. \u201cPeeling-off\u201d is a manual DALK technique, which separates the anterior stroma by pulling the deep stromal lamellae following the plane of their lowest adhesion, which is usually very deep. The purpose of this study is to measure the residual bed thickness achievable with this technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective case series of \u201cPeeling-off\u201d DALK cases performed between January 2014 and January 2021 with at least 1 year of follow-up. Indications for DALK, intraoperative and postoperative complications, residual recipient bed thickness at 1 day and at 1 month after surgery, and postoperative best corrected visual acuity (BCVA) at 1 year of follow up were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>42 eyes (42 patients) underwent DALK performed with \u201cPeeling-off\u201d technique. Indications for surgery were keratoconus in 33 eyes and stromal scar in 9 eyes. \u201cPeeling-off\u201d technique was used as a rescue approach to perform a DALK after a failed Big-Bubble in all cases, and also failed Air-Visco-Bubble in some cases. No intraoperative and postoperative complications were recorded. Residual recipient bed thickness was deep and regular, measuring 42 microns at 1 day postoperative (range 21\u201365 microns) and 23 microns (range 17\u201326 microns) at 1 month postoperative. Mean postoperative BCVA at 1 year of follow up was 0.18 logMAR\u2009\u00b1\u20090.09.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\u201cPeeling-off\u201d DALK is a valuable manual technique that achieves a deep stromal plane with optimal visual outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11206721221132622","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T02:08:40Z","timestamp":1666836520000},"page":"900-904","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Rediscovering a valuable manual Deep Anterior Lamellar Keratoplasty (DALK) technique: Outcomes of 42 \"Peeling-off\" DALK"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0219-8009","authenticated-orcid":false,"given":"Caterina","family":"Sarnicola","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Ospedale San Donato AUSL Toscana Sud-est, Arezzo, Italy"},{"name":"Clinica degli Occhi Sarnicola, Grosseto, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2552-2126","authenticated-orcid":false,"given":"Vincenzo","family":"Sarnicola","sequence":"additional","affiliation":[{"name":"Clinica degli Occhi Sarnicola, Grosseto, Italy"},{"name":"Ambulatorio di Chirurgia Oculare Santa Lucia, Grosseto, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Romani","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Ospedale San Donato AUSL Toscana Sud-est, Arezzo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9345-6055","authenticated-orcid":false,"given":"Enrica","family":"Sarnicola","sequence":"additional","affiliation":[{"name":"Clinica degli Occhi Sarnicola, Grosseto, Italy"},{"name":"Ambulatorio di Chirurgia Oculare Santa Lucia, Grosseto, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"bibr1-11206721221132622","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.11.002"},{"key":"bibr2-11206721221132622","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31823d0412"},{"key":"bibr3-11206721221132622","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60437-1"},{"key":"bibr4-11206721221132622","doi-asserted-by":"publisher","DOI":"10.1159\/000381495"},{"key":"bibr5-11206721221132622","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2006.10.043"},{"key":"bibr6-11206721221132622","volume-title":"Corneal transplantation: a history in profiles. 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