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The following is a summary of “Outcomes of Penetrating Keratoplasty vs Lamellar Endothelial Keratoplasty in Iridocorneal Endothelial Syndrome: A Systematic Review and Meta-Analysis,” published in the April 2025 issue of American Journal of Ophthalmology by Tóth et al. 

Researchers conducted a retrospective study to compare surgical outcomes following penetrating keratoplasty (PK), Descemet stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty (DMEK) in individuals with iridocorneal endothelial (ICE) syndrome.  

They pre-registered the study in the PROSPERO database (registration number: CRD42024539444) and retrieved eligible studies from Embase, MEDLINE (via PubMed), and the Cochrane Central Register of Controlled Trials (CENTRAL) up to April 24, 2024. Studies included those reporting clinical outcomes—graft survival, best spectacle-corrected visual acuity (BSCVA), and endothelial cell density (ECD)—in individuals with ICE syndrome after PK, DSEK, or DMEK. Data extraction and synthesis followed the Cochrane Handbook, and the risk of bias was evaluated by the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and Joanna Briggs Institute Critical Appraisal Checklists. Meta-analyses were executed using a random-effects model, and heterogeneity was estimated with Q-test and I² statistics.  

The results showed that 19 of the 1,963 screened studies were included in the meta-analysis. Pooled Kaplan-Meier curves indicated better graft survival after PK compared to DSEK in patients with ICE syndrome. No significant difference (P =0.92) was observed in BSCVA improvement between PK [-0.77 (95% CI, -1.45 to -0.09)], DSEK [-0.87 (95% CI, -1.35 to -0.39)], and DMEK [-0.85 (95% CI, -1.07 to -0.62)]. No significant differences in ECD were found between DSEK and DMEK at 6 (P =0.88) and 12 months (P =0.33) postoperatively. Analysis of individual patient data (IPD) revealed no significant difference in graft survival between those with or without glaucoma (-0.04 ± 0.50 SEM; P=0.940) or cataract surgery (-0.45 ± 0.40 SEM; P =0.265).  

Investigators concluded that PK showed superior graft survival compared to DSEK in patients with ICE, but further research was needed for definitive conclusions, while improvements in BSCVA were similar across PK, DSEK, and DMEK, and glaucoma surgery did not significantly affect graft survival. 

Source: ajo.com/article/S0002-9394(25)00194-1/fulltext