深板层角膜移植术与穿透性角膜移植术治疗圆锥角膜临床疗效的meta分析

目的:探讨临床研究中深板层角膜移植术(DLKP)和穿透性角膜移植术(PKP)治疗圆锥角膜的有效性与安全性。方法:应用循证医学的研究方法检索美国国立医学图书馆(PubMed数据库)、循证医学数据库(Cochrane library)、荷兰医学与文摘(EMbase.com)和中国知网(CNKI),对有关比较DLKP和PKP在治疗圆锥角膜方面临床疗效的随机对照与非随机对照试验进行方法学质量评价,并根据评价结果对临床随机对照研究进行Meta分析。统计分析采用RevMan5.0。结果:共纳入DLKP和PKP治疗圆锥角膜的临床对照研究14项(3137只眼),其中随机对照试验3项,非随机对照试验8项。在这11项研究中,结果显示,在术后视力方面,DLKP组最佳矫正视力(BCVA)达0.5及1.0以上的眼数较PKP组少,且DLKP组术后残余屈光不正的等效球镜度数较PKP组更偏向于近视,而术后散光情况两组无显著差异;在保护角膜内皮方面,DLKP组术后平均角膜内皮细胞计数显著多于PKP组;在移植排斥反应方面,DLKP组术后总移植排斥反应发生率较PKP低,尤其是内皮型移植排斥反应,DLKP组基本不发生。结论:根据目前现有的研究资料表明,尽管PKP在术后最佳矫正视力和屈光力方面有一定优势,但DLKP术后发生内皮型排斥反应和内皮衰竭的几率低,安全性更高。因此,DLKP为治疗轻、中度圆锥角膜提供了一个安全有效的手术选择方式。

Meta-analysis of Deep Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus Concerning Clinical Effectiveness

Objective: To evaluate and compare the therapeutic outcomes of DLKP and PKP in patients suffered from keratoconus.Methods: Searches of the peer-reviewed literatures were conducted in the PubMed,Cochrane Library,EMBASE and CNKI.Methodological quality analysis and meta-analysis were carried out according to the principle of Evidence-Based Medicine.The statistical analysis was performed using Review Manager 5.0.Results: Eleven studies involving 2950 eyes were identified that compared the results of DLKP and PKP for keratoconus directly.Of those studies reporting vision and refractive data,fewer patients receiving DLKP achieved a best-corrected visual acuity of 0.5 and 1.0 than the patients receiving PKP;Patients with DLKP had more myopia than those with PKP,but the astigmatisms were comparative.Mean endothelial cell density number was higher in the DLKP group and the difference was significant.To these studies,endothelial immune graft rejection did not occur after DLKP,and PKP group had a higher overall graft rejection rate than DLKP group.Conclusion: According to the available datas,despite PKP had some advantages on refractive results,DLKP makes the risk of endothelial rejection to be avoided and can reduce the risk of late endothelial failure.Thus DLKP is a safe and effective alternate when selecting operative method in the treatment of mild and moderate keratoconus.