A 35-year-old with stable keratoconus, Kmax 55 D, corneal thickness 450 μm, and contact lens intolerance desires visual rehabilitation. The most appropriate surgical option is:
- A Deep anterior lamellar keratoplasty (DALK) ✓
- B Topography-guided PRK
- C Intracorneal ring segments (ICRS)
- D Implantable collamer lens (ICL)
Correct answer: A. Deep anterior lamellar keratoplasty (DALK)
Explanation
This patient has advanced keratoconus with high Kmax and contact lens intolerance, indicating failure of conservative management. DALK is the procedure of choice for keratoconus with good endothelial function, as it replaces stromal tissue while preserving the host Descemet membrane and endothelium. ICRS are indicated for mild to moderate disease. PRK is contraindicated in keratoconus. ICL does not address corneal irregularity.
Reference: Cornea, 4th Edition (Krachmer, Mannis, Holland), 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.