Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: a meta-analysis.
Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: a meta-analysis.
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深前板层角膜移植术与穿透性角膜移植术治疗圆锥角膜的疗效和安全性：荟萃分析
DOI：
10.1371/journal.pone.0113332
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Sheng M
中科院分区：
文献类型：
--
作者：
Liu H;Chen Y;Wang P;Li B;Wang W;Su Y;Sheng M
目的比较深前板层角膜移植术（DALK）和穿透性角膜移植术（PKP）治疗圆锥角膜的疗效。方法检索Pubmed、EMBASE、科克伦图书馆、Web of science等数据库。合格的研究应至少包括以下因素之一：最佳矫正视力（BCVA）、术后等效球镜（SE）、术后散光和内皮细胞计数（ECC）、中央角膜厚度（CCT）、移植排斥和移植失败，其中BCVA、移植排斥和移植失败作为主要结局指标，术后SE、散光、CCT和ECC作为次要结局指标。由于缺乏随机临床试验（RCT），队列研究和前瞻性研究被认为是合格的。结果共纳入16个临床试验，共6625眼，其中DALK组1185眼，PKP组5440眼。使用科克伦回顾管理器（RevMan）5.0版软件分析结局。DALK组术后最佳矫正视力明显优于PKP组（OR = 0.48; 95%CI 0.39 ~ 0.60; p<0.001）。DALK组移植物排斥反应发生率低于PKP组（OR = 0.28; 95%CI 0.15 ~ 0.50; p<0.001）。然而，DALK组和PKP组的移植物失败率相似（OR = 1.05; 95%CI 0.81 - 1.36; p = 0.73）。DALK和PKP组之间SE（p = 0.70）、散光（p = 0.14）和CCT（p = 0.58）的次要结局无显著差异。DALK组ECC明显高于PKP组（p<0.001）。对术后并发症、高眼压和白内障进行分析，DALK组并发症发生率低于PKP组（高眼压，OR 0.22，95%CI 0.11-0.44，P<0.001）（白内障，OR 0.22，95%CI 0.08-0.61，P = 0.004）。无出血和眼内炎病例报告。结论DALK的视力结果与PKP不同。DALK和PKP之间的移植物失败率相似。DALK组术后并发症发生率较低，表明DALK与PKP相比疗效较低，但安全性较高。
Purpose To evaluate difference in therapeutic outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for the clinical treatment of keratoconus. Methods A comprehensive search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of science. Eligible studies should include at least one of the following factors: best corrected visual acuity (BCVA), postoperative spherical equivalent (SE), postoperative astigmatism and endothelial cell count (ECC), central corneal thickness (CCT), graft rejection and graft failure, of which BCVA, graft rejection and graft failure were used as the primary outcome measures, and postoperative SE, astigmatism, CCT and ECC as the secondary outcome measures. Given the lack of randomized clinical trials (RCTs), cohort studies and prospective studies were considered eligible. Results Sixteen clinical trials involving 6625 eyes were included in this review, including 1185 eyes in DALK group, and 5440 eyes in PKP group. The outcomes were analyzed using Cochrane Review Manager (RevMan) version 5.0 software. The postoperative BCVA in DALK group was significantly better than that in PKP group (OR = 0.48; 95%CI 0.39 to 0.60; p<0.001). There were fewer cases of graft rejection in DALK group than those in PKP group (OR = 0.28; 95%CI 0.15 to 0.50; p<0.001). Nevertheless the rate of graft failure was similar between DALK and PKP groups (OR = 1.05; 95%CI 0.81 to 1.36; p = 0.73). There were no significant differences in the secondary outcomes of SE (p = 0.70), astigmatism (p = 0.14) and CCT (p = 0.58) between DALK and PKP groups. And ECC in DALK group was significantly higher than PKP group (p<0.001). The postoperative complications, high intraocular pressure (high-IOP) and cataract were analyzed, fewer cases of complications occurred in DALK group than those in PKP group (high-IOP, OR 0.22, 95% CI 0.11–0.44, P<0.001) (cataract, OR 0.22; 95% CI 0.08–0.61, P = 0.004). And no cases of expulsive hemorrhage and endophthalmitis were reported. Conclusion The visual outcomes for DALK were not equivalent to PKP. The rate of graft failure was similar between DALK and PKP. Fewer postoperative complications occurred in DALK group, indicating that compared with PKP, DALK has lower efficacy but higher safety.
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