Abstract
PurposeThe aim of our investigation was to conduct a quantitative meta-analysis of the present world literature comparing the major surgical outcomes of penetrating keratoplasty (PKP) to lamellar procedures. Our goal is that clinicians, eye bank administrators, and health policy makers will be able to utilize this study in implementing decisions in regards to corneal transplantation.MethodsPooled measures of association were with odds ratios and because of study heterogeneity, the pooled effects were assumed to follow a random effects model (DerSimonian-Laird). The comparisons were between 1) PKP’s and all lamellar procedures (anterior AND posterior) and then 2) between PKP’s and all anterior lamellar procedures and 3) PKP and all posterior lamellar procedures.ResultsFor PKP vs anterior lamellar procedures, the pooled odds ratio for rejection of PKP over lamellar keratoplasty (LK) was 3.56 (95% CI: 1.76-7.20) and for outright failure, the pooled odds ratio of PKP failure vs LK was 2.85 (95% CI: 0.84-9.66). For posterior lamellar procedures, the pooled odds ratio for rejection of PKP over LK was 1.52 (95% CI: 1.00-2.32). The pooled odds ratio for outright failure of PKP over posterior lamellar procedures was 2.09 (95% CI: 0.57-7.59). The follow up time was significantly longer for full transplants than for lamellar procedures.ConclusionsFor both anterior and posterior lamellar procedures, the odds ratios comparing rejection of full transplants to lamellar procedures (both anterior and posterior individually) were significantly higher in the PKP group. For outright failure, the PKP group also had a higher risk of failure than the lamellar groups but this was not statistically significant in either instance (anterior or posterior). Some of the clinical differences benefitting lamellar procedures may at least be partly explained by follow up time differences between groups and this needs to be accounted for more rigorously in future studies.
Highlights
The multi layered cornea tissue is being exploited by modern cornea surgeons based on the anatomic diversity of its several layers [1]
For penetrating keratoplasty (PKP) vs anterior lamellar procedures, the pooled odds ratio for rejection of PKP over lamellar keratoplasty (LK) was 3.56 and for outright failure, the pooled odds ratio of PKP failure vs LK was 2.85
The pooled odds ratio for rejection of PKP over LK was 1.52
Summary
The multi layered cornea tissue is being exploited by modern cornea surgeons based on the anatomic diversity of its several layers [1]. For over the greater part of a century, the surgical technique of choice has been penetrating keratoplasty (PKP) [3], in which all five layers of the cornea are removed and replaced with donor tissue [4]. Immunological rejection of the donor cornea’s endothelial cells may occur. LK potentially addresses the issue of immunological incompatibilities between host and donor tissue (at least in part), as diseased layers of the cornea are removed and healthy tissue is preserved [8].
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