后弹力层内皮角膜移植术与后弹力层剥除内皮角膜移植术的疗效与安全性：一项系统评价与荟萃分析

Efficacy and safety of Descemet's membrane endothelial keratoplasty versus Descemet's stripping endothelial keratoplasty: A systematic review and meta-analysis.

作者信息

Li Saiqun, Liu Liangping, Wang Wei, Huang Ting, Zhong Xingwu, Yuan Jin, Liang Lingyi

机构信息

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Hainan Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China.

出版信息

PLoS One. 2017 Dec 18;12(12):e0182275. doi: 10.1371/journal.pone.0182275. eCollection 2017.

PURPOSE

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).

METHODS

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.

RESULTS

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).

CONCLUSION

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.

目的

基于当前证据，比较Descemet膜内皮角膜移植术（DMEK）与Descemet膜剥除内皮角膜移植术（DSEK）的有效性和安全性。

方法

全面检索PubMed、Embase、Web of Science、Cochrane数据库及会议摘要，查找比较DMEK和DSEK有效性与安全性的研究。有效性结局指标为术后最佳矫正视力（BCVA）。安全性结局指标包括术后内皮细胞密度（ECD）以及诸如植片脱离、植片排斥、植片失败、术后眼压升高（IOP）、组织丢失等并发症。使用Stata 13.0软件通过随机效应模型汇总结局指标。采用Q统计量和I²/H²统计量评估异质性。使用漏斗图、Begg秩相关检验以及Egger或Harbard线性回归评估发表偏倚。

结果

19篇文章符合纳入标准，DMEK组和DSEK组分别纳入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显著更好，ECD相当，但植片脱离率更高（BCVA：平均差（MD）=-0.15，95%可信区间（CI）=-0.19至-0.11，P<0.001；ECD：MD = 14.88，95% CI = -181.50至211.27，P = 0.882；植片脱离率：比值比（OR）= 4.56，95% CI = 2.43至8.58，P<0.001）。除术后ECD在DSEK组高于DMEK组外，基于在DMEK学习阶段收集数据的研究汇总估计，学习曲线对BCVA和植片脱离率的比较结局没有显著影响（ECD（学习曲线）：MD = -361.24，95% CI = -649.42至-73.07，P = 0.014）。