Romano, Vito 
ORCID: 0000-0002-5148-7643, Passaro, Maria Laura, Bachmann, Bjoern, Baydoun, Lamis, Dhubhghaill, Sorcha Ni, Dickman, Mor, Levis, Hannah J ORCID: 0000-0002-3923-1178, Parekh, Mohit, Rodriguez-Calvo-De-Mora, Marina, Costagliola, Ciro et al (show 2 more authors)
(2023)
Combined or sequential DMEK in cases of cataract and Fuchs endothelial corneal dystrophy-A systematic review and meta-analysis.
ACTA OPHTHALMOLOGICA, 102 (1).
e22-e30.
Abstract
To compare the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed after phacoemulsification and intraocular lens (IOL) implantation (sequential DMEK) and DMEK combined with phacoemulsification and IOL implantation (combined DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and cataract. Systematic literature review and meta-analysis performed according to the PRISMA guidelines and registered in PROSPERO. Literature searches were conducted in Medline and Scopus. Comparative studies reporting sequential DMEK and combined DMEK in FECD patients were included. The main outcome measure of the study was the corrected distance visual acuity (CDVA) improvement. Secondary outcomes were postoperative endothelial cell density (ECD), rebubbling rate and primary graft failure rate. Bias risk was assessed and a quality appraisal of the body of evidence was completed using the Cochrane Robin-I tool. A total of 667 eyes (5 studies) were included in this review, 292 eyes (43.77%) underwent a combined DMEK, while 375 (56.22%) eyes underwent a sequential DMEK surgery. We found no evidence of a difference between the two groups (mean difference, 95% CI) regarding: (1) CDVA improvement (-0.06; -0.14, 0.03 LogMAR; 3 studies, I<sup>2</sup> : 0%; p = 0.86); (2) postoperative ECD (-62; -190, 67 cells/mm<sup>2</sup> ; 4 studies, I<sup>2</sup> : 67%; p = 0.35); (3) rebubbling (risks ratio: 1.04; 0.59, 1.85; 4 studies, I<sup>2</sup> : 48%; p = 0.89); and primary graft failure rate (risks ratio: 0.91; 0.32, 2.57; 3 studies, I<sup>2</sup> : 0%; p = 0.86). Of all the 5 non-randomized studies, all (100%) were graded as low quality. The overall quality of the analysed studies was low. Randomized controlled trials are needed to confirm no difference or superiority of one approach in terms of CDVA, endothelial cell count and postoperative complication rate between the two arms.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | cataract, combined, DMEK, Fuch's dystrophy, keratoplasty, phacoemulsification, sequential |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 05 Oct 2023 12:56 |
| Last Modified: | 18 Jan 2024 20:07 |
| DOI: | 10.1111/aos.15691 |
| Open Access URL: | https://doi.org/10.1111/aos.15691 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173454 |
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