目的：比较深板层角膜移植(DALK)与穿透性角膜移植(PK)治疗基质性角膜营养不良的有效性和安全性。

方法：系统回顾性Meta分析。对比较视力\〖最佳矫正视力(BCVA)(LogMAR)\〗和角膜内皮细胞计数(ECC)以及DALK和PK手术的安全性结果，包括移植物相关结果和术中术后并发症。直到2019-06，使用Embase、PubMed和Google Scholar搜索符合条件的研究。

结果：最终纳入了350例黄斑点状CD患者(男性59.71%)的五项对比研究。两种手术后的平均BCVA无明显差异。然而，经过DALK手术，术后两年角膜ECC明显升高(WMD=401.62 cell/mm²， 95% CI： 285.39-517.85， P<0.001)，与接受PK手术的患者相比，移植物和内皮细胞排斥反应率显著降低(RR=0.30， 95% CI： 0.14-0.64， P=0.002； RR=0.09， 95% CI： 0.02-0.46， P=0.004)。但是，DALK手术增加了术中后弹力膜穿孔和术后双前房的风险(P<0.001)。

结论：对于间质性CDs患者，DALK治疗在随访期间相对更有效，更安全，减少排斥反应，提高视觉效果。

METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity \〖best-corrected visual acuity(BCVA)(LogMAR)\〗 and corneal endothelial cell count(ECC)as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference(WMD)and risk ratios(RRs), respectively, along with their respective 95% confidence intervals(CIs).

RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy(59.71% males)were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively(WMD=401.62 cell/mm², 95% CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower(RR=0.30, 95% CI: 0.14-0.64, P=0.002; RR=0.09, 95% CI: 0.02-0.46, P=0.004, respectively)when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet's membrane perforations and postoperative double anterior chamber(All P<0.001).

CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.