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Meta-Analysis
. 2015 Mar 17;10(3):e0119934.
doi: 10.1371/journal.pone.0119934. eCollection 2015.

Graft rejection rate and graft failure rate of penetrating keratoplasty (PKP) vs lamellar procedures: a systematic review

Zarique Z Akanda  1 , Abdul Naeem  1 , Elizabeth Russell  2 , Jillian Belrose  1 , Francie F Si  3 , William G Hodge  3
Affiliations
Meta-Analysis

Graft rejection rate and graft failure rate of penetrating keratoplasty (PKP) vs lamellar procedures: a systematic review

Zarique Z Akanda et al. PLoS One. .

Abstract

Purpose: The 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.

Methods: Pooled 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.

Results: For 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.

Conclusions: For 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Prisma Diagram.
The flow chart of the systematic review process.
Fig 2
Fig 2. The summary Forest plots of the pooled odds ratio for PKP rejection over lamellar rejection.
Fig 3
Fig 3. The summary Forest plots of the pooled odds ratio for PKP failure over lamellar failure.
See this image and copyright information in PMC

References

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