Abstract：
OBJECTIVE: To review the published literature on indications and outcomes of DSAEK/DSEK and DMEK for the treatment of failed penetrating keratoplasty.
METHODS: This is a systematic review and single-arm meta-analysis.
METHODS: Literature searches were conducted in PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. Prospective and retrospective studies reporting DSAEK/DSEK or DMEK after failed penetrating keratoplasty were included. Primary outcome measures are graft survival and detachment rates, as well as postoperative visual outcomes.
RESULTS: A total of 25 studies with 970 patients/989 eyes were included, comprising 735 patients with 746 eyes which underwent DSAEK/DSEK surgery and 235 patients with 243 eyes which underwent DMEK surgery, all of them following a previously failed PK. There were no randomized controlled studies. In all of the DSAEK-PK studies, the graft failure rate was 18% (10%, 26%), the detachment rate was 15% (9%, 22%) and the rejection rate was 7% (3%, 12%) by the time of the last follow-up. And in all of the DMEK-PK studies, the graft failure rate was 14% (4%, 27%), the detachment rate was 42% (28%, 56%) and the rejection rate was 7% (2%, 16%). The mean visual acuity of the DSAEK-PK and DMEK-PK groups is 0.65 ± 0.18 and 0.43 ± 0.23 logMAR, respectively, at 6 months postoperatively.
CONCLUSIONS: Endothelial keratoplasty for treatment of failed penetrating keratoplasty led to improved vision and graft clarity in most recipients. Though graft survival rates and rejection rates were comparable between the two groups, the DMEK-PK group showed better visual outcomes with higher detachment rate.
METHODS: This is a systematic review and single-arm meta-analysis.
METHODS: Literature searches were conducted in PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. Prospective and retrospective studies reporting DSAEK/DSEK or DMEK after failed penetrating keratoplasty were included. Primary outcome measures are graft survival and detachment rates, as well as postoperative visual outcomes.
RESULTS: A total of 25 studies with 970 patients/989 eyes were included, comprising 735 patients with 746 eyes which underwent DSAEK/DSEK surgery and 235 patients with 243 eyes which underwent DMEK surgery, all of them following a previously failed PK. There were no randomized controlled studies. In all of the DSAEK-PK studies, the graft failure rate was 18% (10%, 26%), the detachment rate was 15% (9%, 22%) and the rejection rate was 7% (3%, 12%) by the time of the last follow-up. And in all of the DMEK-PK studies, the graft failure rate was 14% (4%, 27%), the detachment rate was 42% (28%, 56%) and the rejection rate was 7% (2%, 16%). The mean visual acuity of the DSAEK-PK and DMEK-PK groups is 0.65 ± 0.18 and 0.43 ± 0.23 logMAR, respectively, at 6 months postoperatively.
CONCLUSIONS: Endothelial keratoplasty for treatment of failed penetrating keratoplasty led to improved vision and graft clarity in most recipients. Though graft survival rates and rejection rates were comparable between the two groups, the DMEK-PK group showed better visual outcomes with higher detachment rate.
摘要：
目的：回顾已发表的关于DSAEK/DSEK和DMEK治疗失败的穿透性角膜移植术的适应证和结果的文献。
方法：这是一项系统综述和单臂荟萃分析。
方法：文献检索在PubMed，Embase,WebofScience,和Cochrane系统评价数据库。纳入了穿透性角膜移植术失败后DSAEK/DSEK或DMEK的前瞻性和回顾性研究。主要结果指标是移植物存活率和脱离率，以及术后视觉结果。
结果：共纳入25项研究，涉及970名患者/989只眼，包括735例746眼接受DSAEK/DSEK手术的患者和235例243眼接受DMEK手术的患者，所有这些都遵循先前失败的PK。没有随机对照研究。在所有的DSAEK-PK研究中,移植物失败率为18%(10%，26%），脱离率为15%(9%，22%)，排斥率为7%(3%，12%)由末次随访时间。在所有的DMEK-PK研究中,移植物失败率为14%(4%，27%），脱离率为42%(28%，56%)，排斥率为7%(2%，16%)。DSAEK-PK和DMEK-PK组的平均视力为0.65±0.18和0.43±0.23logMAR，分别,术后6个月。
结论：内皮角膜移植术用于治疗失败的穿透性角膜移植术可改善大多数受者的视力和移植物透明度。尽管两组之间的移植物存活率和排斥率相当，DMEK-PK组的视觉结局更好,脱离率更高.
方法：这是一项系统综述和单臂荟萃分析。
方法：文献检索在PubMed，Embase,WebofScience,和Cochrane系统评价数据库。纳入了穿透性角膜移植术失败后DSAEK/DSEK或DMEK的前瞻性和回顾性研究。主要结果指标是移植物存活率和脱离率，以及术后视觉结果。
结果：共纳入25项研究，涉及970名患者/989只眼，包括735例746眼接受DSAEK/DSEK手术的患者和235例243眼接受DMEK手术的患者，所有这些都遵循先前失败的PK。没有随机对照研究。在所有的DSAEK-PK研究中,移植物失败率为18%(10%，26%），脱离率为15%(9%，22%)，排斥率为7%(3%，12%)由末次随访时间。在所有的DMEK-PK研究中,移植物失败率为14%(4%，27%），脱离率为42%(28%，56%)，排斥率为7%(2%，16%)。DSAEK-PK和DMEK-PK组的平均视力为0.65±0.18和0.43±0.23logMAR，分别,术后6个月。
结论：内皮角膜移植术用于治疗失败的穿透性角膜移植术可改善大多数受者的视力和移植物透明度。尽管两组之间的移植物存活率和排斥率相当，DMEK-PK组的视觉结局更好,脱离率更高.
