Christin Henein1, Mayank A Nanavaty2. 1. Sussex Eye Hospital, Brighton & Sussex University H ospitals NHS Trust, Eastern Road, Brighton, BN6 5BF, United Kingdom. 2. Sussex Eye Hospital, Brighton & Sussex University H ospitals NHS Trust, Eastern Road, Brighton, BN6 5BF, United Kingdom. Electronic address: mayank.nanavaty@bsuh.nhs.uk.
Abstract
AIM: Perception of reduced incidence of graft rejection after deep anterior lamellar keratoplasty (DALK) has attracted many surgeons towards this technique in keratoconus. This review aims to compare the visual, refractive and graft outcomes after penetrating keratoplasty (PK) and DALK for keratoconus. METHODS: Electronic searches of PubMed, MEDLINE, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), metaRegister of Controlled Trials (mRCT), ClinicalTrial.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were performed. We included randomized control trials (RCTs) and comparative studies to assess primary and secondary outcomes after PK and DALK in eyes with keratoconus. Primary outcome was best-corrected visual acuity (BCVA) LogMAR at ≥6 months. Secondary outcomes included number of patients with BCVA≥0 LogMAR, uncorrected visual acuity (UCVA) LogMAR, spherical equivalent (SE), refractive and keratometric astigmatism, endothelial cell density (ECD) cell/mm2, graft rejection and graft survival. RESULTS: Eighteen studies (including 2 RCTs) compared DALK (965 eyes) and PK (2402 eyes) for keratoconus. There was strong evidence through RCTs suggesting better LogMAR BCVA at ≥6 months and better LogMAR UCVA with PK; reduced refractive astigmatism and rejection with DALK and no difference in SE and keratometric astigmatism. Moreover, there was weak evidence to suggest better BCVA≥0 LogMAR after PK and no difference in ECD between the two techniques. CONCLUSIONS: Despite the popularity of DALK amongst corneal surgeons for keratoconus, there is a paucity of high quality RCTs. The existing limited evidence confirms reduced rejection and refractive astigmatism with DALK but better visual outcomes with PK. Internationally agreed data sets and follow-up protocol are warranted.
AIM: Perception of reduced incidence of graft rejection after deep anterior lamellar keratoplasty (DALK) has attracted many surgeons towards this technique in keratoconus. This review aims to compare the visual, refractive and graft outcomes after penetrating keratoplasty (PK) and DALK for keratoconus. METHODS: Electronic searches of PubMed, MEDLINE, EMBASE, Latin American and Caribbean Health Sciences Literature database (LILACS), metaRegister of Controlled Trials (mRCT), ClinicalTrial.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were performed. We included randomized control trials (RCTs) and comparative studies to assess primary and secondary outcomes after PK and DALK in eyes with keratoconus. Primary outcome was best-corrected visual acuity (BCVA) LogMAR at ≥6 months. Secondary outcomes included number of patients with BCVA≥0 LogMAR, uncorrected visual acuity (UCVA) LogMAR, spherical equivalent (SE), refractive and keratometric astigmatism, endothelial cell density (ECD) cell/mm2, graft rejection and graft survival. RESULTS: Eighteen studies (including 2 RCTs) compared DALK (965 eyes) and PK (2402 eyes) for keratoconus. There was strong evidence through RCTs suggesting better LogMAR BCVA at ≥6 months and better LogMAR UCVA with PK; reduced refractive astigmatism and rejection with DALK and no difference in SE and keratometric astigmatism. Moreover, there was weak evidence to suggest better BCVA≥0 LogMAR after PK and no difference in ECD between the two techniques. CONCLUSIONS: Despite the popularity of DALK amongst corneal surgeons for keratoconus, there is a paucity of high quality RCTs. The existing limited evidence confirms reduced rejection and refractive astigmatism with DALK but better visual outcomes with PK. Internationally agreed data sets and follow-up protocol are warranted.
Authors: Asaf Achiron; Boris Knyazer; Boris E Malyugin; Alexandra Belodedova; Olga Antonova; Aslan Gelyastanov; Raimo Tuuminen; Eliya Levinger Journal: Graefes Arch Clin Exp Ophthalmol Date: 2022-07-28 Impact factor: 3.535
Authors: Konstantinos D Andreanos; Kate Hashemi; Myrsini Petrelli; Konstantinos Droutsas; Ilias Georgalas; George D Kymionis Journal: Ophthalmol Ther Date: 2017-07-28