摘要背景 临床上正在广泛开展各种角膜移植术以治疗圆锥角膜,其中深板层角膜移植术(DLKP)是目前的研究热点之一,但其临床疗效及安全性备受关注. 目的 探讨临床研究中DLKP和穿透角膜移植术(PKP)治疗圆锥角膜的有效性与安全性.方法 应用循证医学的研究方法,检索美国国立医学图书馆(PubMed数据库)、循证医学数据库(Cochrane library)、荷兰医学与文摘(EMbase)和中国知网(CNKI),对有关DLKP和PKP治疗圆锥角膜临床疗效的随机对照研究与非随机对照试验进行方法学和质量评价,并根据评价结果对临床随机对照试验(RCT)进行Meta分析.采用RevMan 5.0统计学软件进行统计分析. 结果 共纳入已发表的关于DLKP和PKP治疗圆锥角膜的临床对照研究文献11篇,样本量2950眼,其中RCT3篇,非随机对照试验文献8篇.结果显示,DLKP组患者术后最佳矫正视力(BCVA)≥0.5的眼数少于PKP组,差异有统计学意义(RR=0.91,95％ CI.0.84 ～0.99,P=0.030)；两组BCVA≥1.0者差异不明显.DLKP组术后残余屈光不正的等效球镜度数较PKP组更偏向于近视,但差异无统计学意义(RR=-0.60,95％CI:-1.43 ～0.23,P=0.150),而术后散光情况两组间差异无统计学意义[加权平均数(WMD)=0.21,95％ CI:-0.48～0.91,P=0.550]；在保护角膜内皮方面,DLKP组术后平均角膜内皮细胞计数多于PKP组；在移植排斥反应方面,DLKP组术后总移植排斥反应发生率较PKP低(RR=0.47,95％ CI:0.27 ～0.80,P=0.006),尤其是内皮型移植排斥反应,DLKP组基本不发生(RR=0.06,95％ CI:0.01～ 0.31,P=0.001). 结论 PKP在术后BCVA和屈光力方面有一定优势,但DLKP术后发生内皮型排斥反应和内皮衰竭的概率低,安全性更好.因此,DLKP为治疗轻度、中度圆锥角膜提供了一个安全、有效的手术方式选择.

abstractsBackground 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.