{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:54:04Z","timestamp":1792148044082,"version":"4.4.0"},"reference-count":56,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    While acanthamoeba keratitis (AK) is a sight\u2010threatening corneal infection, a thorough comparison of the outcomes of therapeutic penetrating keratoplasty (PK) and therapeutic deep anterior lamellar keratoplasty (DALK) is lacking. We aimed to compare clinical outcomes of PK and DALK in AK. The study was preregistered in the PROSPERO database (CRD420251233705). A comprehensive search of Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted through 11 November 2025. Eligible studies reported outcomes after PK or DALK in patients with AK, specifically graft survival, best spectacle\u2010corrected visual acuity (BSCVA) and postoperative complications. Of the 1257 studies screened, 28 studies comprising 478 eyes with AK were included in the meta\u2010analysis. Individual participant data (IPD) were available from 11 studies. The pooled graft survival rate was significantly higher after DALK (0.90, 95% CI 0.48\u20130.99) than after PK (0.63, 95% CI 0.54\u20130.71) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.025). No significant difference was observed in either BSCVA improvement between PK (\u22121.00, 95% CI \u20131.36 to \u22120.64) and DALK (\u22121.29, 95% CI \u20132.30 to \u22120.28) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.314), or in postoperative BSCVA between PK (0.97, 95% CI 0.68 to 1.25) and DALK (0.86, 95% CI \u20130.02 to 1.74) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.739). Postoperative complications did not differ significantly between the two procedures (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009\u2265\u20090.91). DALK may provide superior graft survival compared with PK in AK, while visual and postoperative outcomes appear comparable between the two procedures. Within the observed follow\u2010up periods, treatment delay alone was not clearly associated with visual outcomes after PK.\n                  <\/jats:p>","DOI":"10.1111\/aos.70257","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:41:38Z","timestamp":1792147298000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of therapeutic penetrating keratoplasty and deep anterior lamellar keratoplasty in acanthamoeba keratitis: A systematic review and meta\u2010analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9176-9442","authenticated-orcid":false,"given":"G\u00e1bor","family":"T\u00f3th","sequence":"first","affiliation":[{"name":"Experimental Ophthalmology Saarland University  Homburg\/Saar Germany"},{"name":"Kispest Health Institute  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junbo","family":"Wang","sequence":"additional","affiliation":[{"name":"Experimental Ophthalmology Saarland University  Homburg\/Saar Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanhe","family":"Liu","sequence":"additional","affiliation":[{"name":"Experimental Ophthalmology Saarland University  Homburg\/Saar Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2251-6242","authenticated-orcid":false,"given":"Shuailin","family":"Li","sequence":"additional","affiliation":[{"name":"Experimental Ophthalmology Saarland University  Homburg\/Saar Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Szil\u00e1rd","family":"V\u00e1ncsa","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Institute of Pancreatic Diseases Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1ty\u00e1s","family":"Paczk\u00f3","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tam\u00e1s","family":"K\u00f3i","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Department of Stochastics, Institute of Mathematics Budapest University of Technology and Economics  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Hegyi","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Institute of Pancreatic Diseases Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00f3ra","family":"Szentm\u00e1ry","sequence":"additional","affiliation":[{"name":"Experimental Ophthalmology Saarland University  Homburg\/Saar Germany"},{"name":"Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research Saarland University  Homburg\/Saar Germany"},{"name":"Department of Ophthalmology Semmelweis University  Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","DOI":"10.3390\/microorganisms12091801","article-title":"Rethinking keratoplasty for patients with acanthamoeba keratitis: early \u201clow load keratoplasty\u201d in contrast to late optical and therapeutic keratoplasty","volume":"12","author":"Abu Dail Y.","year":"2024","journal-title":"Microorganisms"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS\u2010I: a tool for assessing risk of bias in non\u2010randomised studies of interventions","volume":"12","author":"Ac Sterne 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