Graft Rejection Rate and Graft Failure Rate of Penetrating Keratoplasty (PKP) vs Lamellar Procedures: A Systematic Review

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.

Corneal transplantation for Fuchs´ endothelial dystrophy: A comparison of three surgical techniques concerning 10 year graft survival and visual function

“…In spite of the larger incidence of rejection episodes after penetrating grafts as compared to DSAEK, graft survival of the three corneal transplantation methods) did not differ significantly ( Fig 2 ). The same conclusions could be drawn in other papers that described graft rejection and survival after PKP versus posterior lamellar grafts[ 10 , 11 , 12 ]. Concerning graft survival, similar results were reported for the Cornea Donor Study where PKP and DSAEK survival were analysed during the first 3 postoperative years[ 13 ], and for a 4 years’ follow up study of eyes with secondary endothelial failure[ 12 ].…”

Graft survival and endothelial outcomes after penetrating keratoplasty and Descemet stripping automated endothelial keratoplasty: A systematic review and meta‑analysis

“…A prior meta-analysis performed by Akanda et al (20) in 2015 compared the major surgical outcomes following PK and lamellar procedures. The analysis included 22 studies, three of which were randomized controlled trials and the others were cohort studies.…”

“…Several studies have compared visual outcomes, including uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), intraoperative and postoperative complications, corneal biomechanical properties, corneal resistance factors and graft survival, following PK and DSAEK (3,4,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The objective of the present study was to compare the outcomes of graft survival, endothelial cell loss and vision improvement between PK and DSAEK in the treatment of corneal endothelial disease.…”

Targeted AAV5-Smad7 gene therapy inhibits corneal scarring in vivo

“…Hence, corneal transplantation remains the gold standard for treatment of corneal blindness. However, limited availability of donor corneas and post-transplantation complications including drug-induced toxicity, immunosuppression, and graft failure and rejection limit the clinical success of corneal transplantation [5]. Therefore, there is an unmet clinical need to develop novel therapies for treatment of corneal disorders.…”