Efficacy of Thin and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Influence of Graft Thickness on Postoperative Outcomes: Systematic Review and Meta-analysis - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue American Journal of Ophthalmology Année : 2022

Efficacy of Thin and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Influence of Graft Thickness on Postoperative Outcomes: Systematic Review and Meta-analysis

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PurposeTo conduct a systematic review and meta-analysis on the efficacy of thin and ultrathin Descemet stripping automated endothelial keratoplasty (T-DSAEK and UT-DSAEK, with graft thickness <130 and <100 µm, respectively), depending on graft thickness.DesignSystematic review and meta-analysis.MethodPubMed, Cochrane Library, Embase, ClinicalTrials.gov, and ScienceDirect databases were searched until October 1, 2021. We computed random-effect meta-analysis on postoperative outcomes of T/UT-DSAEK, stratified by graft thickness (<80 μm, 80-100 μm, and 100-130 μm). The main postoperative outcome was visual acuity (logarithm of the minimum angle of resolution [logMAR]). Secondary outcomes were pachymetry (μm), endothelial cell count (cell/mm2), spherical equivalent (diopter [D]), rebubbling rate (%), and rejection rate (%). Meta-regressions compared postoperative outcomes depending on graft thickness and search for putative confusion factors.ResultsWe included 47 articles for a total of 2141 eyes of 2040 patients. T/UT-DSAEK globally improved visual acuity (effect size = −0.38 logMAR [95% confidence interval {CI} −0.46 to −0.30 logMAR]), without difference depending on graft thickness. Overall, pachymetry improved (−60.6 µm [95% CI −101 to −19.7 µm]), endothelial cell count decreased (−1039 cells/mm2 [95% CI −1209 to −868 cells/mm2), spherical equivalent resulted in a hyperopic shift (0.74 D [95% CI −0.50 to 1.97 D), the graft rejection rate was 0.2% (95% CI −0.1% to 0.4%), and the rebubbling rate was 8.7% (95% CI 6.8%-10.5%). Grafts >100 μm induced a hyperopic shift. Metaregressions did not demonstrate differences between the 3 groups (<80 μm, 80-100 μm, or 100-130 μm) in any outcomes.ConclusionAll T/UT-DSAEK thickness groups provided similar visual acuity, pachymetry, endothelial cell count, rejection rate, and rebubbling rate regardless of graft thickness. A hyperopic shift was induced by grafts >100 μm.
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hal-03682152 , version 1 (22-07-2024)

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Lauren Béal, Valentin Navel, Bruno Pereira, Florent Magnier, Stephanie Watson, et al.. Efficacy of Thin and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Influence of Graft Thickness on Postoperative Outcomes: Systematic Review and Meta-analysis. American Journal of Ophthalmology, 2022, 240, pp.170-186. ⟨10.1016/j.ajo.2022.03.022⟩. ⟨hal-03682152⟩
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