ABSTRACT
Background Nowadays,keratoplasty is widely used in the treatment of keratoconus.Deep lamellar keratoplasty(DLKP)is one of the research hotspots.However,its effacacy and safety are still concerned.Objective This paper was to evaluate and compare the therapeutic outcomes between DLKP and penetrating keratoplasty(PKP) for keratoconus.Methods The peer-reviewed and published literature was searched from PubMed database,Cochrane Library,EMBase and CNKI to identify relevant trails comparing DLKP with PKP for keratoconus.Methodological quality and Meta-analysis were carried out according to the principle of evidence-based medicine.The statistical analysis was performed using Review Manager 5.0 software.Results Eleven studies with 2950 eyes were identified that compared the results of DLKP and PKP procedures for keratoconus directly.Of those studies reporting vision and refractive data,less patients underwent DLKP achieved a best corrected visual acuity (BCVA)of≥0.5 than DLKP(RR=0.91,95％ CI:0.84-0.99,P=0.030) ;patients with DALK had severer myopia that those with PKP(RR =-0.60,95％ CI:-1.43-0.23,P =0.150),but the astigmatism was comparative (WMD =0.21,95％ CI:-0.48-0.91,P =0.550).Endothelial cell density values were higher in the DLKP group and the differences were significant.Endothelial immune graft rejection did not occur after DALK,and PKP had a higher overall graft rejection rate than DLKP(RR=0.06,95％ CI:0.01-0.31,P=0.001).Conclusions According to the available data,PKP can imporve the BCVA and refractive results,but DLKP can avoid the risk of endothelial rejection and reduce the risk of late endothelial failure for keratconus.
ABSTRACT
Background Dry eye syndrome is a frequent postoperative complication of laser in situ keratomileusis (LASIK).Some studies reported that the hinge location of corneal flap has influence on dry eye syndrome following LASIK,but others showed inverse views.Objective This systematic review was to evaluate and compare the effects of a superior-and nasal/temporal-hinge location on dry eye syndrome after LASIK.Methods A systematic literature retrieval was conducted in the Medline,Embase,Cochrane Library and CNKI from 1990 to 2011 according to designed searching strategy and relevant words.Published randomized-controlled clinical trial (RCT) data of the effect of superior-and nasal/temporal-hinge location on dry eye syndrome were extracted by two researchers separately.The outcome parameters,such as tear film breakup time (BUT),Schirmer Ⅰ test and corneal sensation were analyzed 1 week,3 months and 6-12 months postoperatively.The statistical analysis was performed using a RevMan 5.0 software and the quality of included literatures were graded according to the Jadad scale.Fixedeffect model was used for the inhomogeneity multiple studies (P≥0.1,homogeneity test I2 ＜50％),and random-effect model was used for the homogeneity studies.Results Ten pieces RCT papers were searched and 3 of them were rejected because of the lack of outcome data.In 7 included studies,652 eyes of 331 patients were involved in the Meta analysis,with the Jadad scores ≥ 3.BUT assessment was performed in 5 trials (530 eyes),Schirmer Ⅰ test evaluation was in 7 trials (652 eyes) and corneal sensation observation was in 4 trials (320 eyes),without significant homogeneity among the relevant literature(I2＜50％).Meta analysis revealed that BUT in the eyes with superior-hinge group was obvious shorter than that in the eyes nasal/temporal-hinge group at 1 week (WMD =-0.42,95％ CI:-0.79 to-0.06,P=0.020),but there was no signifieant difference in 3 months and 6-12 months duration postoperatively.Better corneal sensation was found at postoperative 3 months (WMD=-0.62,95％CI:-l.09 to-0.19,P=0.005) in the nasal/temporal-hinge group,but there was no difference in 1 week and 6-12 months duration postoperatively.No significant difference was seen between the two groups in Schirmer Ⅰ test during the follow-up period (P＞0.05).Conclusions LASIK with nasal/temporal-hinge corneal flap can improve the corneal sensation and relief the dry eye syndrome after LASIK to some extent.More high-quality evidence-based studies are still needed for the further clinical evaluation.
ABSTRACT
Background Nowadays,customized ablation is widely used in the excimer laser corneal refractive Burgery.And the Q-value guide LASIK is one of the research hotspots. Objective Present study was to evaluate and compare the effectiveness of Q-value guide LASIK and standardized LASIK for myopia.Methods A systematic literature retrieval from 2003 through 2010 was conducted in the MEDLINE,CNKI,Cochrane Library,EMBASE.The literature examine possible difierences in uncorrected visual acuity(UCVA),Q-value,higher order aberrations(HOAs),and spherical equivalent(SE) between Q-value guide LASIK and standardized LASIK for correcting myopia.Statistical analysis was performed using a Review Manager 5.0 software.The data was extracted,and the methodological quality was evaluated by two reviewers independently.The quality of included literature was scored according to the Jadad Scale. Results A total of 14 studies involving 1617 patients(2956 eyes)was included in the meta-analysis.Of these fourteen studies,six studies were randomized trials and the other eight studies were retrospective cohort studies.According to the Jadad Scale,2 studies scored 3 points,and the other 12 studies scored 1～2 points.The results showed that the Q-value guide LASIK group had a better postoperative effectiveness in uncorrective visual acuity(UCVA)(WMD=0.04.95% CI 0.00 to 0.08,P<0.05).Q-value(SMD=-1.52,95% CI -2.23 to-0.81,P=0.00),total HOAs (SMD=-1.63,95% CI-2.57 to-0.69,P<0.05) and spherical-like aberrations ( SMD =-1.49,95% CI-2.22 to-0. 76,P<0. 00) after surgery. However, the number of eyes achieved UCVA≥20/20 ( OR= 1.16,95% CI 0. 61 to 2. 19,P=0. 65) ,coma-like aberrations (SMD=-1. 02,95% CI-0. 36to 0.11,P=0.29) and SE (WMD=0.10,95% CI-0.11 to 0.31,P=0.34) after surgery were comparable.Conclusion The effectiveness of Q-value guide LASIK is superior to standardized LASIK for treatment of myopia.High-quality clinical randomized-controlled study should be performed to further evaluate the comparable outcome of Q-value guide LASIK with standard LASIK.