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

## TL;DR

This study compares two corneal transplant methods for macular dystrophy, finding that one offers better vision but higher rejection risks.

## Contribution

A systematic review and meta-analysis comparing DALK and PK for macular corneal dystrophy, focusing on visual outcomes and graft rejection risks.

## Key findings

- DALK showed better best corrected visual acuity compared to PK.
- PK had a higher risk of graft rejection compared to DALK.
- No significant difference was found in glaucoma or cataract risk between the two procedures.

## 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 (I2 = 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.