Yang Ke, Zhao Yang, Lu Hongshuang, Zang Yunxiao, Mao Yu, Hong Jiaxu, Jie Ying
Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, P.R. China.
Department of Ophthalmology, Eye & Ent Hospital, School of Shanghai Medicine, Fudan University, Shanghai 200031, P.R. China.
Exp Ther Med. 2020 Sep;20(3):2794-2804. doi: 10.3892/etm.2020.9010. Epub 2020 Jul 13.
The present study aimed to compare the outcomes of graft survival, endothelial cell loss and vision improvement between penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) for treating corneal endothelium diseases. The PubMed, CENTRAL (Cochrane) and Embase databases were searched for records added until September 20, 2019. The studies considered were two-arm prospective and retrospective studies comparing outcomes of interest between PK and DSAEK. Ultimately, 10 studies were included with a total of 2,634 patients (910 eyes treated with DSAEK; 1,804 eyes treated with PK). Assessment of the summary effect by meta-analysis suggested that, compared with PK treatment, DSAEK was associated with a greater improvement from baseline in best spectacle-corrected visual acuity [difference (diff.) in means of change from baseline=-0.225, 95% CI=-0.341 to -0.109, P<0.001] and a reduced loss of endothelial cell density (diff. in means=-292.05 cells/mm, 95% CI=-419.53 to -146.57 cells/mm, P<0.001). Graft survival rates were similar using either PK or DSAEK (odds ratio=1.005, 95% CI=0.329-3.071, P=0.993). The overall results suggested that DSAEK may have an advantage over PK for corneal endothelial dysfunction in terms of the visual acuity outcome. The absence of definite time frames in the comparisons limits the conclusions on endothelial cell loss and graft survival.
本研究旨在比较穿透性角膜移植术（PK）和Descemet膜剥离自动内皮角膜移植术（DSAEK）治疗角膜内皮疾病时的移植物存活、内皮细胞丢失和视力改善情况。检索了PubMed、CENTRAL（Cochrane）和Embase数据库，纳入截至2019年9月20日添加的记录。纳入的研究为双臂前瞻性和回顾性研究，比较PK和DSAEK之间的相关结果。最终，纳入了10项研究，共2634例患者（910眼接受DSAEK治疗；1804眼接受PK治疗）。通过荟萃分析评估汇总效应表明，与PK治疗相比，DSAEK术后最佳矫正视力较基线有更大改善[基线变化均值差异（diff.）=-0.225，95%CI=-0.341至-0.109，P<0.001]，内皮细胞密度损失减少（均值差异=-292.05个细胞/mm，95%CI=-419.53至-146.57个细胞/mm，P<0.001）。PK或DSAEK的移植物存活率相似（优势比=1.005，95%CI=0.329-3.071，P=0.993）。总体结果表明，就视力结果而言，DSAEK在治疗角膜内皮功能障碍方面可能优于PK。比较中缺乏明确的时间框架限制了关于内皮细胞丢失和移植物存活的结论。
