الفهرس 
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Abstract
DALK is the procedure of choice to treat corneal stromal diseases that require keratoplasty in the setting of healthy endothelium with keratoconus being the most common indication.
In this study, six hundred and six DALK surgeries were performed between October 2015 and October 2021. Intraoperative DM perforation occurred in 176 patients with an incidence of 29%. Seventy-three planned DALK surgery were converted to PK with an incidence of 12%. We evaluated the outcomes on 110 eyes of 108 patients who met the inclusion criteria and had complete records and at least 12 months follow up.
We divided our cohort of patients into 4 groups; Cases that underwent DALK surgery with intact DM, DALK cases that had DM microperforation, DALK cases that had DM macroperforation, and DALK cases that had intraoperative conversion to PK following DM perforation.
The primary objective of this study is to evaluate the clinical outcomes of DALK with intraoperative Descemet’s membrane (DM) perforation in terms of visual outcomes and graft survival. The secondary objective is to compare four groups of DALK; cases with intact DM, cases that had DM microperforation, cases that had DM macroperforation, and cases that had intraoperative conversion to PK following DM perforation in terms of BCVA, graft survival and endothelial cell (EC) density at the end of the follow up.