比较Descemet膜内皮角膜移植术与Descemet剥脱自动内皮角膜移植术术后结果参数的Meta分析。

Meta-Analysis of Postoperative Outcome Parameters Comparing Descemet Membrane Endothelial Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty.

作者信息

Pavlovic Ivana, Shajari Mehdi, Herrmann Eva, Schmack Ingo, Lencova Anna, Kohnen Thomas

机构信息

*Department of Ophthalmology, Goethe University, Frankfurt, Germany; and †Institut of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt, Germany.

出版信息

Cornea. 2017 Dec;36(12):1445-1451. doi: 10.1097/ICO.0000000000001384.

DOI:10.1097/ICO.0000000000001384

PMID:28957976

Abstract

PURPOSE

This meta-analysis compares Descemet membrane endothelial keratoplasty (DMEK) with Descemet stripping automated endothelial keratoplasty (DSAEK) to evaluate their strength and weakness profiles.

DESIGN

Meta-analysis.

METHODS

We performed a meta-analysis and searched the peer-reviewed literature in PubMed, Cochrane Library, Web of Science, and Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective and retrospective trials performing and comparing DMEK and DSAEK were included. Effects were calculated as odds ratios or standardized mean differences.

RESULTS

A total of 11 studies with a total of 723 eyes (350 DMEK and 373 DSAEK) were included. No significant difference was found regarding the total detachment rate, graft failure, and rejection. One of 340 eyes undergoing DMEK showed total detachment and 5 of 363 eyes undergoing DSAEK showed total detachment (P = 0.28). Six of 280 eyes undergoing DMEK showed graft failure; 1 of 313 eyes undergoing DSAEK developed this complication (P = 0.18). No rejection was observed in 158 eyes undergoing DMEK; 4 cases of rejection occurred in 196 eyes undergoing DSAEK (P = 0.37). No significant difference was found regarding endothelial cell loss (P = 0.48). There was a significantly higher partial detachment rate with DMEK: 88 of 340 eyes undergoing DMEK showed partial detachment; 16 of 363 eyes undergoing DSAEK showed this complication (P < 0.00001). DMEK was superior in best-corrected visual acuity after 6 months (P < 0.001), subjective evaluation of visual acuity (P = 0.001), patient satisfaction (P < 0.001), and was the method preferred by patients (P = 0.001).

CONCLUSIONS

DMEK and DSAEK have a similar complication profile. However, the superiority in the visual outcome and patient satisfaction makes DMEK the preferred option for most patients.

摘要

目的

本荟萃分析比较了Descemet膜内皮角膜移植术（DMEK）和Descemet膜剥除自动内皮角膜移植术（DSAEK），以评估它们的优缺点。

设计

荟萃分析。

方法

我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，在PubMed、Cochrane图书馆、科学网和Embase中检索了同行评审文献。纳入了进行DMEK和DSAEK并比较二者的前瞻性和回顾性试验。效应以比值比或标准化均数差值计算。

结果

共纳入11项研究，总计723只眼（350只接受DMEK，373只接受DSAEK）。在完全脱离率、植片失败和排斥反应方面未发现显著差异。接受DMEK的340只眼中有1只出现完全脱离，接受DSAEK的363只眼中有5只出现完全脱离（P = 0.28）。接受DMEK的280只眼中有6只出现植片失败；接受DSAEK的313只眼中有1只出现此并发症（P = 0.18）。接受DMEK的158只眼中未观察到排斥反应；接受DSAEK的196只眼中有4例发生排斥反应（P = 0.37）。在内皮细胞丢失方面未发现显著差异（P = 0.48）。DMEK的部分脱离率显著更高：接受DMEK的340只眼中有88只出现部分脱离；接受DSAEK的363只眼中有16只出现此并发症（P < 0.00001）。DMEK在术后6个月的最佳矫正视力（P < 0.001）、视力主观评估（P = 0.001）、患者满意度（P < 0.001）方面更优，且是患者首选的方法（P = 0.001）。