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Purpose To evaluate the outcomes of a 9-mm deep anterior lamellar keratoplasty (DALK) use of Moria pre-calibrated trephine to optimize pneumatic dissection.Design Prospective, noncomparative, interventional case series. Par2cipants: A total of 1118 consecutive eyes with stromal disease, with at least 1 postoperative examination 1 month after complete suture removal.Methods Standardized DALK was performed by fellows and senior surgeons: (1) deep trephination of the recipient bed 450 to 550 mm in depth and 9 mm in diameter; (2) pneumatic dissection; (3) debulking of approximately 80% of the anterior stroma; (4) removal of the deep stroma (bubble roof) from a central 6-mm optical zone; and (5) transplanta5on of a 9-mm anterior corneal lamella cut by microkeratome-assisted dissection (400-mm head) and sutured with a double running 10–0 nylon suture. Success rate, best spectacle-corrected visual acuity (BSCVA) and refractive astigmatism (RA) were evaluated.Results Large diameter DALK was successfully performed in 1079 of 1118 eyes (97%). Pneumatic dissection was successful in 396 of 489 eyes (81%) with keratoconus without scarring, in 164 of 315 eyes (52%) with keratoconus with scarring, in 69 of 87 eyes (79%) with other DALK indications not associated with stromal scarring and in 190 of 276 eyes (69%) with other DALK indications associated with stromal scarring. Mean logMAR BSCVA was 0.10± 0.16. Mean RA was 2.7± 1.4 D. RA was greater than 4.5 D but less than 6 D in 51 eyes (5%) while RA was greater than 6 D in 15 eyes (1%). The 5- and 10-year cumulative probability for stromal rejection was 2% at 5 years and 3% and for graft survival was 99% and 98%, respectively.Conclusion The use of Moria pre-calibrated trephine optimizes pneumatic dissection during large diameter DALK, which provides visual outcomes superior to those reported for PK with excellent 10-year survival regardless of surgical indication