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2026, Vol: 10, Issue: 1
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Review Article
Online Published: 09 Jan 2026
 


Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis

Faisal Saeed Al-ghamdi, Sarah Saleh Taishan, Razan Owaid Alanazi, Fatemah Saleh Alsalem, Ahmad Abdulhamid Al-mabadi, Amani Ali Madkhali, Halah Bin Helayel.


Abstract
Keratoconus is a progressive corneal ectasia that can lead to visual impairment. Penetrating keratoplasty (PK) has traditionally been the standard surgical intervention. However, deep anterior lamellar keratoplasty (DALK) has emerged as a potential alternative with fewer postoperative complications due to preservation of the patient’s endothelium. The comparative efficacy of PK versus DALK remains debated. This systematic review and meta-analysis followed PRISMA 2020 guidelines. Medline (via PubMed) and Google Scholar were searched from inception to November 2024 for randomized controlled trials and observational studies comparing PK and DALK in keratoconus patients. Twenty-seven studies involving 2,152 patients (PK: 1,105; DALK: 1,047) were included. Primary outcomes assessed included best-corrected visual acuity (BCVA), spherical equivalent (SE), refractive cylinder (RC), topography cylinder (TC), graft rejection episodes (GRE), and overall complications. Study quality was evaluated using the National Institutes of Health (NIH) and the Revised Cochrane Risk of Bias (RoB 2) tool for randomized trials. There were no significant differences between PK and DALK in BCVA (MD = -0.00; p-value=0.92), RC (MD = 0.28; p-value=0.26), or TC (MD = 0.15; p-value=0.46). DALK showed a significantly higher SE (MD = 0.97; p<0.001). PK was associated with significantly higher risks of GRE (OR = 2.69; p<0.00001) and complications (OR = 3.17; p-value=0.02). DALK and PK provide similar visual acuity outcomes, but DALK offers a lower risk of graft rejection and complications. DALK might be a safer alternative for selected patients.

Key words: Deep anterior lamellar keratoplasty, keratoconus, penetrating keratoplasty, keratoconus, systematic review.


 
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How to Cite this Article
Pubmed Style

Al-ghamdi FS, Taishan SS, Alanazi RO, Alsalem FS, Al-mabadi AA, Madkhali AA, Helayel HB. Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis. IJMDC. 2026; 10(1): 324-340. doi:10.24911/IJMDC.51-1764050803

Web Style

Al-ghamdi FS, Taishan SS, Alanazi RO, Alsalem FS, Al-mabadi AA, Madkhali AA, Helayel HB. Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis. https://www.ijmdc.com/?mno=299230 [Access: January 25, 2026]. doi:10.24911/IJMDC.51-1764050803

AMA (American Medical Association) Style

Al-ghamdi FS, Taishan SS, Alanazi RO, Alsalem FS, Al-mabadi AA, Madkhali AA, Helayel HB. Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis. IJMDC. 2026; 10(1): 324-340. doi:10.24911/IJMDC.51-1764050803


Vancouver/ICMJE Style

Al-ghamdi FS, Taishan SS, Alanazi RO, Alsalem FS, Al-mabadi AA, Madkhali AA, Helayel HB. Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis. IJMDC. (2026), [cited January 25, 2026]; 10(1): 324-340. doi:10.24911/IJMDC.51-1764050803


Harvard Style

Al-ghamdi, F. S., Taishan, . S. S., Alanazi, . R. O., Alsalem, . F. S., Al-mabadi, . A. A., Madkhali, . A. A. & Helayel, . H. B. (2026) Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis. IJMDC, 10 (1), 324-340. doi:10.24911/IJMDC.51-1764050803


Turabian Style

Al-ghamdi, Faisal Saeed, Sarah Saleh Taishan, Razan Owaid Alanazi, Fatemah Saleh Alsalem, Ahmad Abdulhamid Al-mabadi, Amani Ali Madkhali, and Halah Bin Helayel. 2026. Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 10 (1), 324-340. doi:10.24911/IJMDC.51-1764050803


Chicago Style

Al-ghamdi, Faisal Saeed, Sarah Saleh Taishan, Razan Owaid Alanazi, Fatemah Saleh Alsalem, Ahmad Abdulhamid Al-mabadi, Amani Ali Madkhali, and Halah Bin Helayel. "Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries 10 (2026), 324-340. doi:10.24911/IJMDC.51-1764050803


MLA (The Modern Language Association) Style

Al-ghamdi, Faisal Saeed, Sarah Saleh Taishan, Razan Owaid Alanazi, Fatemah Saleh Alsalem, Ahmad Abdulhamid Al-mabadi, Amani Ali Madkhali, and Halah Bin Helayel. "Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries 10.1 (2026), 324-340. Print. doi:10.24911/IJMDC.51-1764050803


APA (American Psychological Association) Style

Al-ghamdi, F. S., Taishan, . S. S., Alanazi, . R. O., Alsalem, . F. S., Al-mabadi, . A. A., Madkhali, . A. A. & Helayel, . H. B. (2026) Comparing outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 10 (1), 324-340. doi:10.24911/IJMDC.51-1764050803




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