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

The present study aimed to compare the outcomes of graft survival, endothelial cell loss and vision improvement between penetrating keratoplasty (PK) and Descemet stripping automated endothelial keratoplasty (DSAEK) for treating corneal endothelium diseases. The PubMed, CENTRAL (Cochrane) and Embase databases were searched for records added until September 20, 2019. The studies considered were two-arm prospective and retrospective studies comparing outcomes of interest between PK and DSAEK. Ultimately, 10 studies were included with a total of 2,634 patients (910 eyes treated with DSAEK; 1,804 eyes treated with PK). Assessment of the summary effect by meta-analysis suggested that, compared with PK treatment, DSAEK was associated with a greater improvement from baseline in best spectacle-corrected visual acuity [difference (diff.) in means of change from baseline=-0.225, 95% CI=-0.341 to -0.109, P<0.001] and a reduced loss of endothelial cell density (diff. in means=-292.05 cells/mm(2), 95% CI=-419.53 to -146.57 cells/mm(2), P<0.001). Graft survival rates were similar using either PK or DSAEK (odds ratio=1.005, 95% CI=0.329-3.071, P=0.993). The overall results suggested that DSAEK may have an advantage over PK for corneal endothelial dysfunction in terms of the visual acuity outcome. The absence of definite time frames in the comparisons limits the conclusions on endothelial cell loss and graft survival.