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Zarique Zaowaad Akanda, Abdul Naeem, Elizabeth Russell, Jillian Belrose, William Hodge, ; Graft Rejection Rate and Graft Failure Rate of PKP vs DSAEK: A Systematic Review. Invest. Ophthalmol. Vis. Sci. 2014;55(13):896.
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In the past decade there has been an increasing trend of performing posterior lamellar keratoplasty over penetrating keratoplasty (PKP) for corneal transplantation. We aimed to systemically review the world literature to assess whether there is sufficient evidence to differentiate Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) outcomes from PKP outcomes with respect to failure rates and endothelial rejection.
Keywords were searched in major literature databases to identify relevant randomized clinical studies and cohort studies which directly compared PKP to DSAEK quantitavely. Only studies with N>30 were included. A three step screening and data abstraction process was performed by two masked observers independently. Study quality was assessed using the Down’s and Black assessment tool. A metaregression was performed to assess any factors that contributed to the results other than the surgical procedure.
A total of 2156 patients were studied from 6 cohort studies and 2 randomized trials. The pooled odds ratio of endothelial rejection from PKP vs DSAEK was 1.52 (95% CI 1.00-2.31). The pooled odds ratio for outright graft failure of PKP vs DSAEK was 2.09 (95% CI 0.574-7.591). Metaregression of study size, study type and study quality showed no significant factors on the outcomes studied.
There is a trend toward improved outcomes with DSAEK over PKP for both rejections and outright failures. However neither was statistically significant even though the total sample was very large. This indicates that the clinical benefit of DSAEK over PKP for these outcomes is small.
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