title: Effect of Graft Thickness on Visual Acuity After Descemet Stripping Endothelial Keratoplasty: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To assess the relationship between graft thickness and best-corrected visual acuity (BCVA) after Descemet stripping endothelial keratoplasty (DSEK).
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  PubMed, EMBASE, Web of Science, and conference abstracts were searched for studies published up to October 2015 with standard systematic review methodology. Eligibility criteria included studies evaluating graft thickness in primary DSEK and visual outcomes. There were no restrictions to study design, study population, or language. Correlation coefficients were pooled using random-effects models.
  
  
  RESULTS
  Of 480 articles and conference abstracts, 31 met inclusion criteria (2214 eyes) after full-text review. Twenty-three studies assessed correlations between BCVA and graft thickness, and 8 studies used different statistical methods. All associations were reported dimensionless. Studies generally had small sample sizes and were heterogeneous, especially with respect to data and analysis quality (P = .02). Most studies did not measure BCVA in a standardized manner. The pooled correlation coefficient for graft thickness vs BCVA was 0.20 (95% CI, 0.14-0.26) for 17 studies without data concerns; this did not include 7 studies (815 eyes) that used different statistical methods and did not find significant associations.
  
  
  CONCLUSIONS
  There is insufficient evidence that graft thickness is clinically important with respect to BCVA after DSEK, with meta-analysis suggesting a weak relationship. Although well-designed longitudinal studies with standardized measurements of visual acuity and graft thickness are necessary to better characterize this relationship, current evidence suggests that graft thickness is not important for surgical planning.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Katrin
authors.initials: K
authors.lastname: Wacker
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: William M
authors.initials: WM
authors.lastname: Bourne
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. Electronic address: patel.sanjay@mayo.edu.
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Patel
mesh_terms: D003315:Cornea / Q000473:pathology*; D015715:Corneal Edema / Q000503:physiopathology / Q000601:surgery; D016208:Databases, Factual; D057111:Descemet Stripping Endothelial Keratoplasty; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D009929:Organ Size; D011785:Quality Assurance, Health Care; D014792:Visual Acuity / Q000502:physiology*