背景:角膜移植的数量正在上升,目的是治疗一系列疾病,从营养不良到外伤或化学烧伤引起的角膜混浊。此手术后的屈光结果通常无法预测,并且与高水平的散光有关。然而,有许多技术可以减少散光并提高患者的生活质量。目的:目的是比较接受手术治疗的患者角膜移植术后术后视力(logMAR)和角膜散光(屈光度)的改善,影响术后散光的减少,并确定最有效的方法。搜索方法和选择标准:对包括PubMed在内的在线电子数据库进行了彻底的搜索,胚芽酶,OvidMEDLINE,Scopus,和WebofScience,使用包含以下短语的组合:术后散光,角膜移植术后散光,前板层角膜移植术(ALK),深前板层角膜移植术(DALK),后板层角膜移植术,角膜内皮移植术(EK),穿透性角膜移植术(PK),角膜移植,角膜移植术,屈光手术,角膜屈光手术,准分子激光原位角膜磨镶术(LASIK),和飞秒LASIK.这是为了确定所有讨论术后或角膜移植术后散光的屈光手术的英文出版物。这些参考书目搜索了2010年至2023年之间出版的英语出版物。我们继续查看每个检测到的记录的参考列表。数据提取:研究特征,如研究设计,样本量,参与者信息,执行的操作,和临床结果均被提取。数据统计分析:使用综合荟萃分析软件(2014年3.3.070版)进行分析。P值的阈值0.05被认为是统计学上显著的。所有效应大小均报告为具有95%置信区间(CI)的平均值的标准化差异(Stddiff),并以图形方式显示为森林地块。出版偏倚以标准误差的漏斗图表示,以平均值表示。使用四种方法来评估研究之间的异质性:Q值,I2,卡方(χ2),和tau平方。主要结果:我们纳入了21项研究,将1539只接受PKP角膜移植手术的眼睛随机分组,DALK,或DSEAK技术。结果表明,激光手术后视力的改善最显著,角膜散光显著降低,如DALK后的飞秒辅助角膜切开术和DSEAK后的PKP和LASIK。
Background: The number of corneal transplants is rising, with the aim to treat a spectrum of diseases ranging from dystrophies to corneal opacities caused by trauma or chemical burns. Refractive outcomes after this procedure are often impossible to predict and associated with high levels of astigmatism. However, there are many techniques that affect the reduction of astigmatism and improve the quality of life of patients. Objectives: The aim was to compare the improvement in postoperative visual acuity (logMAR) and amount of corneal astigmatism (Diopters) after corneal keratoplasty in patients who additionally underwent a surgical procedure, which affects the reduction in postoperative astigmatism, and to determine the most effective method. Search Methods and Selection Criteria: A thorough search was carried out across online electronic databases including PubMed, Embrase, Ovid MEDLINE, Scopus, and Web of Science, using combinations containing the following phrases: postoperative astigmatism, post-keratoplasty astigmatism, anterior lamellar keratoplasty (ALK), deep anterior lamellar keratoplasty (DALK), posterior lamellar keratoplasty, endothelial keratoplasty (EK), penetrating keratoplasty (PK), corneal transplant, keratoplasty, refractive surgery, kerato-refractive surgery, laser in situ keratomileusis (LASIK), and femtosecond LASIK. This was to determine all English-language publications that discuss refractive operations for postoperative or post-keratoplasty astigmatism. These bibliographies were searched for English-language publications published between 2010 and 2023. We proceeded to review each detected record\'s reference list. Data Extraction: Study characteristics such as study design, sample size, participant information, operations performed, and clinical outcomes were all extracted. Data Statistical Analyses: The Comprehensive Meta-Analysis software (version 3.3.070, 2014) was used to perform the analysis. The threshold of 0.05 for p-values was considered statistically significant. All effect sizes are reported as standardized differences (Std diff) in means with a 95% confidence interval (CI) and visualized graphically as forest plots. Publication bias is presented as a funnel plot of standard error by Std diff in means. Four methods were used to evaluate the heterogeneity among the studies: Q-value, I2, chi-square (χ2), and tau-squared. Main Results: We included 21 studies that randomized 1539 eyes that underwent corneal transplantation surgery either by PKP, DALK, or DSEAK techniques. The results showed the most significant improvement in the visual acuity and significant decrease in the corneal astigmatism after laser surgery procedures, like femtosecond-assisted keratotomy after DALK and PKP and LASIK after DSEAK.