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Review
. 2025 Aug 6:2025:8867750.
doi: 10.1155/joph/8867750. eCollection 2025.

Efficacy and Safety of Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Corneal Macular Dystrophy: A Systematic Review and Meta-Analysis

Abdelaziz A Awad  1 , Abdelrahman M Elettreby  2 , Ahmed A Abo Elnaga  2 , Mohamed A Alsaied  2 , Dalia Kamal Ewis  3 , Yousef R Alnomani  4 , Fatma Mohammed  5 , Mazen M Sinjab  6   7   8 , Abdulla Turki Alsubaey  9 , Zaki Shannak  9 , Hashem Abu Serhan  9
Affiliations
Review

Efficacy and Safety of Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Corneal Macular Dystrophy: A Systematic Review and Meta-Analysis

Abdelaziz A Awad et al. J Ophthalmol. .

Abstract

Purpose: To compare efficacy and safety for deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK) for macular corneal dystrophy. Methods: Following PRISMA guidelines, we searched four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) to identify eligible studies reported up to January 2024. Using STATA 17, we reported outcomes as log risk ratios (log RRs) or mean difference (SMD) and confidence intervals (CIs). A p value ≤ 0.05 is considered statistically significant. Results: DALK was superior to PK in terms of BCVA (Hedge's g: -0.32 with 95% CI [-0.64, -0.01], p=0.05), PK was associated with a higher risk of graft rejection in comparison with DALK (log RR: 1.21 with 95% CI [0.25, 2.18], p=0.01), and there was no difference between PK and DALK in terms of risk of glaucoma, cataract (log RR: -0.02 with 95% CI [-1.00, 0.95], p=0.96), and (log RR: 0.09 with 95% CI [-0.53, 0.71], p=0.78). The pooled data were homogeneous (I 2 = 0%; p=0.84), respectively. Conclusion: This study suggests that PK, compared to DALK, is associated with worse visual outcomes, with a lower risk of recurrence and a higher risk of graft rejection in macular corneal dystrophy patients.

Keywords: corneal macular dystrophy; corneal transplant; deep anterior lamellar keratoplasty; penetrating keratoplasty; stromal dystrophy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Best corrected visual acuity forest plot.
Figure 3
Figure 3
Graft rejection forest plot.
See this image and copyright information in PMC

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