Graft survival and endothelial outcomes after penetrating keratoplasty and Descemet stripping automated endothelial keratoplasty: A systematic review and meta‑analysis

Yang,Ke; Zhao,Yang; Lu,Hongshuang; Zang,Yunxiao; Mao,Yu; Hong,Jiaxu; Jie,Ying

doi:10.3892/etm.2020.9010

Graft survival and endothelial outcomes after penetrating keratoplasty and Descemet stripping automated endothelial keratoplasty: A systematic review and meta‑analysis

Authors:
- Ke Yang
- Yang Zhao
- Hongshuang Lu
- Yunxiao Zang
- Yu Mao
- Jiaxu Hong
- Ying Jie
View Affiliations

Affiliations: 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
Published online on: July 13, 2020 https://doi.org/10.3892/etm.2020.9010
Pages: 2794-2804
Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

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/mm2, 95% CI=‑419.53 to ‑146.57 cells/mm2, 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.

View Figures

View References

1	Patel SV: Graft survival and endothelial outcomes in the new era of endothelial keratoplasty. Exp Eye Res. 95:40–47. 2012.PubMed/NCBI View Article : Google Scholar
2	Ple-Plakon PA and Shtein RM: Trends in corneal transplantation: Indications and techniques. Curr Opin Ophthalmol. 25:300–305. 2014.PubMed/NCBI View Article : Google Scholar
3	Price MO and Price FW Jr: Endothelial keratoplasty-a review. Clin Exp Ophthalmol. 38:128–140. 2010.PubMed/NCBI View Article : Google Scholar
4	Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ and Shtein RM: Descemet's stripping endothelial keratoplasty: Safety and outcomes: A report by the American Academy of Ophthalmology. Ophthalmology. 116:1818–1830. 2009.PubMed/NCBI View Article : Google Scholar
5	Park CY, Lee JK, Gore PK, Lim CY and Chuck RS: Keratoplasty in the United States: A 10-year review from 2005 through 2014. Opthalmology. 122:2432–2442. 2015.PubMed/NCBI View Article : Google Scholar
6	Dickman MM, Peeters JM, vonden Biggelaur FJ, Ambergen TA, van Dongen MC, Kruit PJ and Nuijts RM: Changing practice patterns and long-term outcomes of endothelialversus penetrating keratoplasty: A prospective dutch registry study. Am J Opthalmol. 170:133–142. 2016.PubMed/NCBI View Article : Google Scholar
7	Williams KKM, Galettis R, Jones V, Mills R and Coster D: The Australian Corneal Graft Resitry-2015 Report. Available at: https://dspace.flinders.edu.au/scmhai/handle/2328/35402. Published 2015. Accessed Feb 16, 2020.
8	Tan D, Ang M, Arundhati A and Khor WB: Development of selectivelamellar keratoplasty within an Asian corneal transplant program: The Singapore Corneal Transplant Study. Trans Am Opthalmol Soc. 113(T10)2015.PubMed/NCBI
9	Ang M, Mehta JS, Lim F, Bose S, Htoon HM and Tan D: Endothelial cell loss and graft survival after Descemet's stripping automated endothelial keratoplasty and penetrating keratoplasty. Ophthalmology. 119:2239–2244. 2012.PubMed/NCBI View Article : Google Scholar
10	Ang M, Soh Y, Htoon HM, Mehta JS and Tan D: Five-year graft survival comparing descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. Ophthalmology. 123:1646–1652. 2016.PubMed/NCBI View Article : Google Scholar
11	Bahar I, Kaiserman I, Levinger E, Sansanayudh W, Slomovic AR and Rootman DS: Retrospective contralateral study comparing descemet stripping automated endothelial keratoplasty with penetrating keratoplasty. Cornea. 28:485–488. 2009.PubMed/NCBI View Article : Google Scholar
12	Bahar I, Kaiserman I, McAllum P, Slomovic A and Rootman D: Comparison of posterior lamellar keratoplasty techniques to penetrating keratoplasty. Ophthalmology. 115:1525–1533. 2008.PubMed/NCBI View Article : Google Scholar
13	Hjortdal J and Ehlers N: Descemet's stripping automated endothelial keratoplasty and penetrating keratoplasty for Fuchs' endothelial dystrophy. Acta Ophthalmol. 87:310–314. 2009.PubMed/NCBI View Article : Google Scholar
14	Ishiyama S, Mori Y, Nejima R, Tokudome T, Shimmura S, Miyata K and Amano S: Comparison of long-term outcomes of visual function and endothelial cell survival after descemet stripping automated endothelial keratoplasty and penetrating keratoplasty using mixed-effects models. Cornea. 35:1526–1532. 2016.PubMed/NCBI View Article : Google Scholar
15	Kim SE, Lim SA, Byun YS and Joo CK: Comparison of long-term clinical outcomes between Descemet's stripping automated endothelial keratoplasty and penetrating keratoplasty in patients with bullous keratopathy. Korean J Ophthalmol. 30:443–450. 2016.PubMed/NCBI View Article : Google Scholar
16	Price MO, Gorovoy M, Price FW Jr, Benetz BA, Menegay HJ and Lass JH: Descemet's stripping automated endothelial keratoplasty: Three-year graft and endothelial cell survival compared with penetrating keratoplasty. Ophthalmology. 120:246–251. 2013.PubMed/NCBI View Article : Google Scholar
17	Uchino Y, Shimmura S, Yamaguchi T, Kawakita T, Matsumoto Y, Negishi K and Tsubota K: Comparison of corneal thickness and haze in DSAEK and penetrating keratoplasty. Cornea. 30:287–290. 2011.PubMed/NCBI View Article : Google Scholar
18	Pedersen IB, Ivarsen A and Hjortdal J: Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure. Acta Ophthalmol. 93:172–177. 2015.PubMed/NCBI View Article : Google Scholar
19	Nanavaty MA, Wang X and Shortt AJ: Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy. Cochrane Database Syst Rev: Cd008420, 2014.
20	Akanda ZZ, Naeem A, Russell E, Belrose J, Si FF and Hodge WG: Graft Rejection rate and graft failure rate of penetrating keratoplasty (PKP) vs lamellar procedures: A systematic review. PLoS One. 10(e0119934)2015.PubMed/NCBI View Article : Google Scholar
21	Moher D, Liberati A, Tetzlaff J, Altman DG and Group P: Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 6(e1000097)2009.PubMed/NCBI View Article : Google Scholar
22	Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, et al: ROBINS-I: A tool for assessing risk of bias in non-randomized studies of interventions. BMJ. 355(i4919)2016.PubMed/NCBI View Article : Google Scholar
23	Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rücker G, Harbord RM, Schmid CH, et al: Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 343(d4002)2011.PubMed/NCBI View Article : Google Scholar
24	Price MO, Calhoun P, Kollman C, Price FW Jr and Lass JH: Descemet stripping endothelial keratoplasty: Ten-year endothelial cell loss compared with penetrating keratoplasty. Opthalmology. 123:1421–1427. 2016.PubMed/NCBI View Article : Google Scholar