Dataset Information

Endothelial keratoplasty versus repeat penetrating keratoplasty after failed penetrating keratoplasty: A systematic review and meta-analysis.

ABSTRACT:

Objective

This study sought to compare graft survival, graft rejection and the visual acuity outcome of endothelial keratoplasty (EK) with repeat penetrating keratoplasty (PK) after failed PK.

Methods

A systematic literature search with subsequent screening of the identified articles was conducted to obtain potentially eligible randomized clinical trials (RCTs) and comparative cohort studies. To assess the methodological quality of the included studies, the Jadad Scale or Newcastle-Ottawa Scale (NOS) was used based on the study design. To calculate the pooled odds ratios (ORs) for graft survival, graft rejection and the visual acuity outcome with 95% confidential intervals (CIs), a fixed- or random-effects model was applied based on the heterogeneity across studies.

Results

Four comparative cohort studies (n = 649 eyes) comparing the outcome of EK with repeat PK after failed PK were included in this review. These studies were considered high quality, with NOS scores ranging from 6 to 9. The EK group showed a significantly lower risk of graft rejection than the repeat PK group [0.43 (95% CI: 0.23-0.80, P = 0.007)]. In addition, no significant differences were observed in a comparison of graft survival and visual acuity (P values ranged from 0.81 to 0.97 using the Der-Simonian and Laird random-effects model).

Conclusions

As an alternative to repeat PK, EK after failed PK allows for potential reduction of the risk of graft rejection; however, it does not appear to confer a significant advantage in graft survival or visual acuity.

SUBMITTER: Wang F

PROVIDER: S-EPMC5495398 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Endothelial keratoplasty versus repeat penetrating keratoplasty after failed penetrating keratoplasty: A systematic review and meta-analysis.

Wang Feng F Zhang Tao T Kang Yan Wei YW He Jing Liang JL Li Shi-Ming SM Li Shao-Wei SW

PloS one 20170703 7

<h4>Objective</h4>This study sought to compare graft survival, graft rejection and the visual acuity outcome of endothelial keratoplasty (EK) with repeat penetrating keratoplasty (PK) after failed PK.<h4>Methods</h4>A systematic literature search with subsequent screening of the identified articles was conducted to obtain potentially eligible randomized clinical trials (RCTs) and comparative cohort studies. To assess the methodological quality of the included studies, the Jadad Scale or Newcastl ...[more]

PMID: 28671976

Similar Datasets

Project description: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).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.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).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.

Project description:ObjectivesTo establish the incidence and risk factors for post penetrating keratoplasty glaucoma (PKKG).MethodsStudies published between 1947 and 2016 regarding penetrating keratoplasty (PK) were identified using an electronic search and reviewed. For search purpose, PKKG was defined as ocular hypertension (> 21mmHg) after PK. The incidence and risk factors of PKKG were extracted for all studies. Pooled incidence, odd ratios (ORs) and 95% confidence intervals (CIs) were calculated.ResultsThirty studies reporting on 27146 patients were included in the analysis of the incidence and risk factors for PKKG. Exact PKKG definitions used in the literature could be classified in to three subgroups: I, ocular hypertension (> 21mmHg) after PK; II, I plus > 4 weeks medical treatment required; III, II plus treatment escalation among patients with preexisting glaucoma. Overall (Definition I) pooled incidence in all studies was 21.5% (95% CI 17.8%, 25.7%). The incidence varied according to different definitions. The highest incidence value was found when only studies using Goldmann tonometer were included (22.5%), while the lowest incidence was found when a strict definition was used and steroid-induced PPKG was excluded (12.1%). The incidence was higher in patients with preexisting glaucoma, bullous keratopathy (BK), aphakia, pseudophakia, failed graft, and surgical indication of trauma. A triple procedure (combined PK with extra capsular cataract extraction and intraocular lens implantation) was not identified as being associated with the increased risk for PKKG.ConclusionsThe overall pooled incidence of PKKG was 21.5%, but it varied according to the criteria used to define the presence of PPKG. Strong risk factors for PKKG included preexisting glaucoma and aphakia, while modest predictors included pseudophakia, regrafting, and preoperative diagnosis like BK and trauma. There may not be sufficient evidence to identify a significant association between a triple procedure and PKKG.

Project description:ImportanceEndothelial morphometric measures have potential value in predicting graft failure after penetrating keratoplasty.ObjectiveTo determine whether preoperative and/or postoperative central morphometric measures (endothelial cell density [ECD], coefficient of variation [CV], and percentage of hexagonality [HEX]) and their postoperative changes are predictive of graft failure caused by endothelial decompensation after penetrating keratoplasty to treat a moderate-risk condition, principally Fuchs dystrophy or pseudophakic corneal edema.DesignIn a subset of Cornea Donor Study participants with graft failure, a central reading center determined preoperative and postoperative ECD, CV, and HEX from available central endothelial specular images.SettingCornea Image Analysis Reading Center of the Specular Microscopy Ancillary Study.ParticipantsEighteen patients with graft failure due to endothelial decompensation and 54 individuals matched for most donor and recipient measures at baseline whose grafts did not fail.Main outcome measureChange in ECD, CV, and HEX values.ResultsPreoperative ECD was not associated with graft failure (P = .43); however, a lower ECD at 6 months was predictive of subsequent failure (P = .004). Coefficient of variation at 6 months was not associated with graft failure in univariate (P = .91) or multivariate (P = .79) analyses. We found a suggestive trend of higher graft failure with lower HEX values at 6 months (P = .02) but not at the established statistical significance (P < .01). The most recent CV or HEX values, as time-dependent variables, were not associated with graft failure (P = .26 and P = .81, respectively). Endothelial cell density values decreased during follow-up, whereas CV and HEX appear to fluctuate without an apparent trend.Conclusions and relevanceEndothelial cell density at 6 months after penetrating keratoplasty is predictive of graft failure, whereas CV and HEX appear to fluctuate postoperatively, possibly indicating an unstable endothelial population in clear and failing grafts.Trial registrationclinicaltrials.gov Identifier: NCT00006411.

Project description:PurposeTo evaluate difference in therapeutic outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for the clinical treatment of keratoconus.MethodsA comprehensive search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of science. Eligible studies should include at least one of the following factors: best corrected visual acuity (BCVA), postoperative spherical equivalent (SE), postoperative astigmatism and endothelial cell count (ECC), central corneal thickness (CCT), graft rejection and graft failure, of which BCVA, graft rejection and graft failure were used as the primary outcome measures, and postoperative SE, astigmatism, CCT and ECC as the secondary outcome measures. Given the lack of randomized clinical trials (RCTs), cohort studies and prospective studies were considered eligible.ResultsSixteen clinical trials involving 6625 eyes were included in this review, including 1185 eyes in DALK group, and 5440 eyes in PKP group. The outcomes were analyzed using Cochrane Review Manager (RevMan) version 5.0 software. The postoperative BCVA in DALK group was significantly better than that in PKP group (OR = 0.48; 95%CI 0.39 to 0.60; p<0.001). There were fewer cases of graft rejection in DALK group than those in PKP group (OR = 0.28; 95%CI 0.15 to 0.50; p<0.001). Nevertheless the rate of graft failure was similar between DALK and PKP groups (OR = 1.05; 95%CI 0.81 to 1.36; p = 0.73). There were no significant differences in the secondary outcomes of SE (p = 0.70), astigmatism (p = 0.14) and CCT (p = 0.58) between DALK and PKP groups. And ECC in DALK group was significantly higher than PKP group (p<0.001). The postoperative complications, high intraocular pressure (high-IOP) and cataract were analyzed, fewer cases of complications occurred in DALK group than those in PKP group (high-IOP, OR 0.22, 95% CI 0.11-0.44, P<0.001) (cataract, OR 0.22; 95% CI 0.08-0.61, P = 0.004). And no cases of expulsive hemorrhage and endophthalmitis were reported.ConclusionThe visual outcomes for DALK were not equivalent to PKP. The rate of graft failure was similar between DALK and PKP. Fewer postoperative complications occurred in DALK group, indicating that compared with PKP, DALK has lower efficacy but higher safety.

Project description:BackgroundWe evaluated the visual outcomes and complications of "endothelium-out" and "endothelium-in" Descemet membrane endothelial keratoplasty (DMEK) graft insertion techniques.Materials and methodsElectronic searches were conducted in CENTRAL, Cochrane databases, PubMed, EMBASE, ClinicalTrials.gov. Study designs included clinical trials, comparative observational studies, and large case series (≥25 eyes). PRISMA guidelines were used for abstracting data and synthesis. Random-effects models were employed for meta-analyses.Results21,323 eyes (95 studies) were included. Eighty-six studies reported on "endothelium-out" techniques; eight studies reported on "endothelium-in" techniques. One study compared "endothelium-out" to "endothelium-in" techniques. Eighteen "endothelium-out" studies reported that 42.5-85% of eyes achieved best-corrected visual acuity (BCVA) ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 58.7% (95% CI 49.4-67.7%,15 studies). Three "endothelium-in" studies reported that 44.7-87.5% of eyes achieved BCVA of ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 62.4% (95% CI 33.9-86.9%). Pooled mean endothelial cell loss was lower in the "endothelium-in" studies (28.1 ± 1.3%, 7 studies) compared to "endothelium-out" studies (36.3 ± 6.9%,10 studies) at 6 months (p = 0.018). Graft re-bubbling rates were higher in the "endothelium-out" studies (26.2%, 95% CI 21.9-30.9%, 74 studies) compared to "endothelium-in" studies (16.5%, 95% CI 8.5-26.4%, 6 studies), although statistical significance was not reached (p = 0.440). Primary graft failure rates were comparable between the two groups (p = 0.552). Quality of evidence was considered low and significant heterogeneity existed amongst the studies.ConclusionReported rates of endothelial cell loss were lower in "endothelium-in" DMEK studies at 6 months compared to "endothelium-out" studies. Outcomes of "endothelium-in" techniques were otherwise comparable to those reported in "endothelium-out" studies. Given the technical challenges encountered in "endothelium-out" procedures, surgeons may consider "endothelium-in" techniques designed for easier intra-operative DMEK graft unfolding. "Endothelium-in" studies evaluating outcomes at longer time points are required before conclusive comparisons between the two techniques can be drawn.

Dataset Information

Endothelial keratoplasty versus repeat penetrating keratoplasty after failed penetrating keratoplasty: A systematic review and meta-analysis.

Objective

Methods

Results

Conclusions

Publications

Endothelial keratoplasty versus repeat penetrating keratoplasty after failed penetrating keratoplasty: A systematic review and meta-analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure