Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus

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• 作者：Christin Henein ; MBBS ; MRes ; Mayank A. Nanavaty ; ^{mayank.nanavaty@bsuh.nhs.uk} (DO ; FRCOphth)
• 关键词：DALK ; PK ; Keratoconus
• 刊名：Contact Lens and Anterior Eye
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：40
• 期：1
• 页码：3-14
• 全文大小：4408 K
• 卷排序：40

文摘

Perception of reduced incidence of graft rejection after deep anterior lamellar keratoplasty (DALK) has attracted many surgeons towards this technique in keratoconus. This review aims to compare the visual, refractive and graft outcomes after penetrating keratoplasty (PK) and DALK for keratoconus.MethodsElectronic searches of PubMed, MEDLINE, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), metaRegister of Controlled Trials (mRCT), ClinicalTrial.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were performed. We included randomized control trials (RCTs) and comparative studies to assess primary and secondary outcomes after PK and DALK in eyes with keratoconus. Primary outcome was best-corrected visual acuity (BCVA) LogMAR at ≥6 months. Secondary outcomes included number of patients with BCVA ≥ 0 LogMAR, uncorrected visual acuity (UCVA) LogMAR, spherical equivalent (SE), refractive and keratometric astigmatism, endothelial cell density (ECD) cell/mm2, graft rejection and graft survival.ResultsEighteen studies (including 2 RCTs) compared DALK (965 eyes) and PK (2402 eyes) for keratoconus. There was strong evidence through RCTs suggesting better LogMAR BCVA at ≥6 months and better LogMAR UCVA with PK; reduced refractive astigmatism and rejection with DALK and no difference in SE and keratometric astigmatism. Moreover, there was weak evidence to suggest better BCVA ≥ 0 LogMAR after PK and no difference in ECD between the two techniques.ConclusionsDespite the popularity of DALK amongst corneal surgeons for keratoconus, there is a paucity of high quality RCTs. The existing limited evidence confirms reduced rejection and refractive astigmatism with DALK but better visual outcomes with PK. Internationally agreed data sets and follow-up protocol are warranted.