Kijonka Magdalena, Nowińska Anna, Wylęgała Edward, Wylęgała Adam, Wróblewska-Czajka Ewa, Kryszan Katarzyna, Dugiełło Bogdan, Orzechowska-Wylęgała Bogusława
Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland.
Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland.
J Clin Med. 2024 Jun 4;13(11):3306. doi: 10.3390/jcm13113306.
: The number of corneal transplants is rising, with the aim to treat a spectrum of diseases ranging from dystrophies to corneal opacities caused by trauma or chemical burns. Refractive outcomes after this procedure are often impossible to predict and associated with high levels of astigmatism. However, there are many techniques that affect the reduction of astigmatism and improve the quality of life of patients. : The aim was to compare the improvement in postoperative visual acuity (logMAR) and amount of corneal astigmatism (Diopters) after corneal keratoplasty in patients who additionally underwent a surgical procedure, which affects the reduction in postoperative astigmatism, and to determine the most effective method. A thorough search was carried out across online electronic databases including PubMed, Embrase, Ovid MEDLINE, Scopus, and Web of Science, using combinations containing the following phrases: postoperative astigmatism, post-keratoplasty astigmatism, anterior lamellar keratoplasty (ALK), deep anterior lamellar keratoplasty (DALK), posterior lamellar keratoplasty, endothelial keratoplasty (EK), penetrating keratoplasty (PK), corneal transplant, keratoplasty, refractive surgery, kerato-refractive surgery, laser in situ keratomileusis (LASIK), and femtosecond LASIK. This was to determine all English-language publications that discuss refractive operations for postoperative or post-keratoplasty astigmatism. These bibliographies were searched for English-language publications published between 2010 and 2023. We proceeded to review each detected record's reference list. Study characteristics such as study design, sample size, participant information, operations performed, and clinical outcomes were all extracted. The Comprehensive Meta-Analysis software (version 3.3.070, 2014) was used to perform the analysis. The threshold of 0.05 for -values was considered statistically significant. All effect sizes are reported as standardized differences (Std diff) in means with a 95% confidence interval (CI) and visualized graphically as forest plots. Publication bias is presented as a funnel plot of standard error by Std diff in means. Four methods were used to evaluate the heterogeneity among the studies: Q-value, I, chi-square (χ), and tau-squared. We included 21 studies that randomized 1539 eyes that underwent corneal transplantation surgery either by PKP, DALK, or DSEAK techniques. The results showed the most significant improvement in the visual acuity and significant decrease in the corneal astigmatism after laser surgery procedures, like femtosecond-assisted keratotomy after DALK and PKP and LASIK after DSEAK.
角膜移植的数量正在上升，目的是治疗一系列疾病，从营养不良到由外伤或化学烧伤引起的角膜混浊。该手术后的屈光结果往往无法预测，且与高度散光相关。然而，有许多技术可影响散光的减少并改善患者的生活质量。目的是比较在角膜移植术后额外接受了一种影响术后散光减少的手术的患者的术后视力（logMAR）改善情况和角膜散光量（屈光度），并确定最有效的方法。我们在包括PubMed、Embrase、Ovid MEDLINE、Scopus和Web of Science在内的在线电子数据库中进行了全面搜索，使用了包含以下短语的组合：术后散光、角膜移植术后散光、前板层角膜移植术（ALK）、深前板层角膜移植术（DALK）、后板层角膜移植术、内皮角膜移植术（EK）、穿透性角膜移植术（PK）、角膜移植、角膜移植术、屈光手术、角膜屈光手术、准分子原位角膜磨镶术（LASIK）和飞秒LASIK。这是为了确定所有讨论术后或角膜移植术后散光屈光手术的英文出版物。在这些文献目录中搜索了2010年至2023年发表的英文出版物。我们接着查看每个检测记录的参考文献列表。提取了研究设计、样本量、参与者信息、所进行的手术以及临床结果等研究特征。使用综合荟萃分析软件（版本3.3.070，2014）进行分析。P值的阈值为0.05被认为具有统计学意义。所有效应量均报告为均值的标准化差异（Std diff），并带有95%置信区间（CI），并以森林图的形式直观呈现。发表偏倚以均值Std diff的标准误漏斗图呈现。我们纳入了21项研究，这些研究将1539只接受了PKP、DALK或DSEAK技术角膜移植手术的眼睛随机分组。结果显示，在激光手术操作后，如DALK和PKP后的飞秒辅助角膜切开术以及DSEAK后的LASIK，视力改善最为显著，角膜散光显著降低。
