Penetrating keratoplasty versus deep anteriror lamellar keratoplasty for macular corneal dystrophy: A meta-analysis.

Study design: We assessed the efficacy of deep anterior lamellar keratoplasty (DALK) and penetrating (PK) for macular corneal dystrophy (MCD) We searched on 4 databases for articles published up to the end of April, 2024. The study's outcome was postoperative visual acuity and other factors that may affect visual outcomes (e.g., spherical equivalent and postoperative complications). Meta-analysis was performed using random-effects or fixed-effect model according to the heterogeneity. We included 6 studies (1 RCT and 5 retrospective studies) comparing DALK (139 eyes) and PK (507 eyes) for MCD. No significant differences were found between the 2 procedures in uncorrected visual acuity, best-corrected visual acuity, and spherical equivalent (p = 0.58, 0.11 and 0.2, respectively). The risk of graft rejection was significantly higher in the PK group than in the DALK group (RR = 0.33; P = 0.001); however, MCD recurrence results were considerably higher in the DALK group than in the PK group (RR = 2.69, p < 0.001). The risk ratio for complications and graft survival have no significant difference between the two interventions (p = 0.9 and 0.62, respectively). Among the studies reviewed, 5 had a moderate risk of bias, while the remaining had a high risk. Our results showed that both PK and DALK have comparable outcomes of postoperative visual acuity, spherical equivalent, graft survival, and complication rate when treating MCD. Although the PK group had a higher rate of graft rejection, the DALK group had a higher recurrence rate.