Posters

Deep anterior lamellar keratoplasty vs penetrating keratoplasty for the treatment of corneal dystrophies: a systematic review and meta-analysis

Poster Details

First Author: A.Reda OMAN

Co Author(s):                     

Abstract Details

Purpose:

The preferential use of lamellar or penetrating surgeries in patients with corneal diseases is a matter of debate. For patients with corneal dystrophies (CDs), there is a paucity of available evidence that supports either techniques.To compare the efficacy and safety of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in the treatment of CDs

Setting:

Meta analysis and systemic  review of literature study in multiple locations

Methods:

A systematic review and meta-analysis was conducted for studies comparing visual acuity (as demonstrated by logMAR best-corrected visual acuity [BCVA]) and corneal endothelial cell count (ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference (WMD) and risk ratios (RRs), respectively, along with their respective 95% confidence intervals (CIs)

Results:

Five comparative studies recruiting 350 patients with macular and/or lattice CD (59.71% males) were included. No significant differences  noted in the mean logMAR BCVA after both types of surgeries, following DALK procedures, corneal ECC  significantly higher two years postoperatively (WMD=401.62 cell/mm2, 95% CI: 285.39 to 517.85, P<0.001), and graft and endothelial rejection rates were significantly lower (RR=0.30, 95% CI, 0.14- 0.64, P=0.002 and RR=0.09, 95% CI, 0.02 to 0.46, P=0.004, respectively) , comparing patients undergoing PK procedures. However, DAL Ksurgery were associated with increased risks of intraoperative Descemet’s membrane perforations and postoperative double anterior chamber P<0.001 for both

Conclusions:

DALK procedures are relatively more efficacious over long-term periods with better safety outcomes than PK in patients with stromal CDs. Adequate training of surgeons might mitigate the risks of DALK-related complications

Financial Disclosure:

None