Efficacy and safety of Descemet's membrane endothelial keratoplasty versus Descemet's stripping endothelial keratoplasty: A systematic review and meta-analysis.
Efficacy and safety of Descemet's membrane endothelial keratoplasty versus Descemet's stripping endothelial keratoplasty: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0182275
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Liang L
中科院分区：
文献类型：
--
作者：
Li S;Liu L;Wang W;Huang T;Zhong X;Yuan J;Liang L
根据现有证据，对后弹力层角膜内皮移植术（DMEK）与后弹力层剥离内皮角膜移植术（DSEK）的效率和安全性进行了比较。全面检索了 Pubmed、Embase、Web of Science、Cochrane 数据库和会议摘要，以查找比较 DMEK 和 DSEK 有效性和安全性的研究。疗效结果是术后最佳矫正视力（BCVA）。安全性结果包括术后内皮细胞密度（ECD）以及移植物脱离、移植物排斥、移植物失败、术后眼压升高（IOP）、组织丢失等并发症。使用Stata 13.0软件的随机效应模型汇总结果。异质性通过Q统计量和I2/H2统计量进行鉴定。使用漏斗图、Begg 等级相关检验和 Egger 或 Horbard 线性回归评估发表偏倚。 19 篇文章符合条件，DMEK 组和 DSEK 组分别包括 1124 只眼和 1254 只眼。总体汇总估计显示，与 DSEK 组相比，DMEK 组术后 BCVA 明显更好，ECD 相当，移植物脱离率增加（BCVA：平均差 (MD) = -0.15，95% CI = -0.19 至 -0.11，P<0.001；ECD：MD = 14.88，95% CI = -181.50 至 211.27，P=0.882；移植物脱离率：OR = 4.56，95% CI = 2.43 至 8.58，P<0.001）。除了 DSEK 组术后 ECD 改为高于 DMEK 组外，根据 DMEK 学习阶段收集数据的研究汇总的估计，学习曲线对 BCVA 和移植物脱离率的比较结果没有显着影响（ECD（学习曲线）：MD = -361.24，95% CI = -649.42 至 -73.07， P = 0.014）。尽管 DMEK 是一种技术难度更大、更具挑战性的手术，但它可能代表 DSEK 的一种安全且更有效的替代方案，用于治疗角膜内皮疾病，即使在其学习曲线期间也是如此。
Based on current evidence, the efficiency and safety of Descemet’s membrane endothelial keratoplasty (DMEK) was compared with that of Descemet’s stripping endothelial keratoplasty (DSEK). Pubmed, Embase, Web of Science, the Cochrane Database and conference abstracts were comprehensively searched for studies that compared the efficacy and safety of DMEK and DSEK. The efficacy outcome was the postoperative best-corrected visual acuity (BCVA). The safety outcomes included the postoperative endothelial cell density (ECD) and complications such as graft detachment, graft rejection, graft failure, postoperative elevated intraocular pressure (IOP), tissue loss, etc. The outcomes were pooled using random-effects models with Stata 13.0 software. Heterogeneity was qualified with Q statistic and I2/H2 statistic. Publication bias was assessed using funnel plot, Begg rank correlation test, and Egger or Horbard linear regression. 19 articles were eligible, and 1124 eyes and 1254 eyes were included in the DMEK and DSEK groups, respectively. The overall pooled estimates showed a significantly better postoperative BCVA, a comparable ECD and an increased graft detachment rate in the DMEK group compared with the DSEK group (BCVA: mean difference (MD) = -0.15, 95% CI = -0.19 to -0.11, P<0.001; ECD: MD = 14.88, 95% CI = -181.50 to 211.27, P = 0.882; graft detachment rate: OR = 4.56, 95% CI = 2.43 to 8.58, P<0.001). Except for the postoperative ECD, which was changed to be higher in the DSEK group than the DMEK group, the learning curve did not have a marked effect on the comparison outcome of the BCVA and graft detachment rate based on the estimates pooled from studies that collected data during the DMEK learning phase (ECD (learning curve): MD = -361.24, 95% CI = -649.42 to -73.07, P = 0.014). Although DMEK is a more technically difficult and challenging procedure, it may represent a safe and more efficient alternative to DSEK for the treatment of corneal endothelial diseases, even during its learning curve.