{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:35:15Z","timestamp":1786649715066,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of repeat deep anterior lamellar keratoplasty (DALK) in patients of previous failed DALK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective analysis of records of seven patients who had undergone repeat DALK following the failure of the primary DALK was done. The indications for repeat surgery, time elapsed since the first surgery, and pre- &amp; postoperative best-corrected visual acuity (BCVA) were noted for all the patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The follow-up period ranged between one- to four-year post repeat DALK. The indication of primary DALK was keratoconus with vernal keratoconjunctivitis (VKC) (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 3), corneal amyloidosis (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 2), Salzman nodular keratopathy (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1), and healed keratitis (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1). The need for repeat surgery arose when the BSCVA dropped to less than 20\/200. The time interval elapsed since the first surgery ranged from two months to four years. Postoperatively, the BSCVA improved from 20\/120 to 20\/30 at the end of one-year post repeat DALK in all except one patient. All regrafts were clear at the most recent examination, performed after a mean period of 18 months after the secondary graft. No complication was encountered during the resurgery. The dissection of the host bed was easier in the second surgery owing to weaker adhesions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The prognosis for repeat DALK for failed DALK is excellent, and the outcomes of secondary grafts were comparable to those of primary DALK grafts. Re DALK offers the advantage of an easier dissection and lower chances of graft rejection compared to penetrating keratoplasty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_2505_22","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T09:06:40Z","timestamp":1686733600000},"page":"2462-2465","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Repeat deep anterior lamellar keratoplasty (DALK) for failed primary DALK"],"prefix":"10.4103","volume":"71","author":[{"given":"Ritu","family":"Arora","sequence":"first","affiliation":[{"name":"Gurunanak Eye Centre, Maulana Azad Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhilasha","family":"Sanoria","sequence":"additional","affiliation":[{"name":"Gurunanak Eye Centre, Maulana Azad Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parul","family":"Jain","sequence":"additional","affiliation":[{"name":"Gurunanak Eye Centre, Maulana Azad Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Gurunanak Eye Centre, Maulana Azad Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palak","family":"Gupta","sequence":"additional","affiliation":[{"name":"Gurunanak Eye Centre, Maulana Azad Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,6,14]]},"reference":[{"key":"R1-20251006","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.jfo.2021.11.001","article-title":"Penetrating keratoplasty","volume":"45","author":"Boucenna","year":"2022","journal-title":"J Fr 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keratoplasty for failed deep anterior lamellar keratoplasty in keratoconus:Incidence, indications, and outcomes","volume":"36","author":"Feizi","year":"2017","journal-title":"Cornea"},{"key":"R9-20251006","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/ICO.0000000000000365","article-title":"Surgical technique for graft exchange after big-bubble deep anterior lamellar keratoplasty","volume":"34","author":"Scorcia","year":"2015","journal-title":"Cornea"},{"key":"R10-20251006","first-page":"e13825","article-title":"Indications of keratoplasty and outcomes of deep anterior lamellar keratoplasty compared to penetrating keratoplasty","volume":"13","author":"Abdelaal","year":"2021","journal-title":"Cureus"},{"key":"R11-20251006","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.3390\/jcm10112421","article-title":"Comparison of long-term outcomes of the lamellar and penetrating keratoplasty approaches in patients with keratoconus","volume":"10","author":"Janiszewska-Bil","year":"2021","journal-title":"J Clin Med"},{"key":"R12-20251006","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1631\/jzus.B1200272","article-title":"Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus","volume":"14","author":"Zhang","year":"2013","journal-title":"J Zhejiang Univ Sci B"},{"key":"R13-20251006","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.ajo.2010.11.020","article-title":"Long-term results of deep anterior lamellar keratoplasty for the treatment of keratoconus","volume":"151","author":"Kubaloglu","year":"2011","journal-title":"Am J Ophthalmol"},{"key":"R14-20251006","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1631\/jzus.B1200272","article-title":"Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating 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