{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:07:19Z","timestamp":1788386839965,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University of Silesia in Katowice"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The number of corneal transplants is rising, with the aim to treat a spectrum of diseases ranging from dystrophies to corneal opacities caused by trauma or chemical burns. Refractive outcomes after this procedure are often impossible to predict and associated with high levels of astigmatism. However, there are many techniques that affect the reduction of astigmatism and improve the quality of life of patients. Objectives: The aim was to compare the improvement in postoperative visual acuity (logMAR) and amount of corneal astigmatism (Diopters) after corneal keratoplasty in patients who additionally underwent a surgical procedure, which affects the reduction in postoperative astigmatism, and to determine the most effective method. Search Methods and Selection Criteria: A thorough search was carried out across online electronic databases including PubMed, Embrase, Ovid MEDLINE, Scopus, and Web of Science, using combinations containing the following phrases: postoperative astigmatism, post-keratoplasty astigmatism, anterior lamellar keratoplasty (ALK), deep anterior lamellar keratoplasty (DALK), posterior lamellar keratoplasty, endothelial keratoplasty (EK), penetrating keratoplasty (PK), corneal transplant, keratoplasty, refractive surgery, kerato-refractive surgery, laser in situ keratomileusis (LASIK), and femtosecond LASIK. This was to determine all English-language publications that discuss refractive operations for postoperative or post-keratoplasty astigmatism. These bibliographies were searched for English-language publications published between 2010 and 2023. We proceeded to review each detected record\u2019s reference list. Data Extraction: Study characteristics such as study design, sample size, participant information, operations performed, and clinical outcomes were all extracted. Data Statistical Analyses: The Comprehensive Meta-Analysis software (version 3.3.070, 2014) was used to perform the analysis. The threshold of 0.05 for p-values was considered statistically significant. All effect sizes are reported as standardized differences (Std diff) in means with a 95% confidence interval (CI) and visualized graphically as forest plots. Publication bias is presented as a funnel plot of standard error by Std diff in means. Four methods were used to evaluate the heterogeneity among the studies: Q-value, I2, chi-square (\u03c72), and tau-squared. Main Results: We included 21 studies that randomized 1539 eyes that underwent corneal transplantation surgery either by PKP, DALK, or DSEAK techniques. The results showed the most significant improvement in the visual acuity and significant decrease in the corneal astigmatism after laser surgery procedures, like femtosecond-assisted keratotomy after DALK and PKP and LASIK after DSEAK.<\/jats:p>","DOI":"10.3390\/jcm13113306","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T05:17:30Z","timestamp":1717478250000},"page":"3306","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Postoperative Astigmatism after Keratoplasty: A Systematic Review Meta-Analysis Based on PRISMA"],"prefix":"10.3390","volume":"13","author":[{"given":"Magdalena","family":"Kijonka","sequence":"first","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-3486","authenticated-orcid":false,"given":"Anna","family":"Nowi\u0144ska","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-5790","authenticated-orcid":false,"given":"Edward","family":"Wyl\u0119ga\u0142a","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Wyl\u0119ga\u0142a","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland"},{"name":"Health Promotion and Obesity Management, Pathophysiology Department, Medical University of Silesia in Katowice, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Wr\u00f3blewska-Czajka","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6164-4009","authenticated-orcid":false,"given":"Katarzyna","family":"Kryszan","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Dugie\u0142\u0142o","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland"},{"name":"Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5950-2425","authenticated-orcid":false,"given":"Bogus\u0142awa","family":"Orzechowska-Wyl\u0119ga\u0142a","sequence":"additional","affiliation":[{"name":"Department of Pediatric Otolaryngology, Head and Neck Surgery, Medical University of Silesia, 40-760 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.4103\/ijo.IJO_95_18","article-title":"Lamellar keratoplasty techniques","volume":"66","author":"Singh","year":"2018","journal-title":"Indian J. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"25158414231204717","DOI":"10.1177\/25158414231204717","article-title":"Management of post-keratoplasty ametropia","volume":"15","author":"Bineshfar","year":"2023","journal-title":"Ther. Adv. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wyl\u0119ga\u0142a, A., Roszkowska, A.M., Kokot, J., Dobrowolski, D., and Wyl\u0119ga\u0142a, E. (2023). Clinical Evaluation of the Efficacy of Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty. J. Clin. Med., 12.","DOI":"10.3390\/jcm12031158"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1097\/j.jcrs.0000000000000634","article-title":"Posterior lamellar keratoplasty: Techniques, outcomes, and recent advances","volume":"47","author":"Yeu","year":"2021","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1038\/s41433-019-0686-6","article-title":"A novel blunt dissection technique to treat modified deep anterior lamellar keratoplasty (DALK)-associated high astigmatism","volume":"34","author":"Elkadim","year":"2020","journal-title":"Eye"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Janiszewska-Bil, D., Czarnota-Nowakowska, B., Krysik, K., Lyssek-Boro\u0144, A., Dobrowolski, D., Grabarek, B.O., and Wyl\u0119ga\u0142a, E. (2021). Comparison of Long-Term Outcomes of the Lamellar and Penetrating Keratoplasty Approaches in Patients with Keratoconus. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112421"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1007\/s00417-023-06298-5","article-title":"Suture-related complications after deep anterior lamellar keratoplasty for keratoconus","volume":"262","author":"Feizi","year":"2024","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e747","DOI":"10.1111\/aos.14653","article-title":"Comparison of manual and femtosecond astigmatic keratotomy in the treatment of postkeratoplasty astigmatism","volume":"99","author":"Sorkin","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.2147\/OPTH.S202054","article-title":"Phakic intraocular lens implantation after deep anterior lamellar keratoplasty: Retrospective case series analysis with long-term follow-up","volume":"13","author":"Malheiro","year":"2019","journal-title":"Clin. Ophthalmol."},{"key":"ref_10","unstructured":"Guccione, L., Mosca, L., Scartozzi, L., Crincoli, E., Fasciani, R., Caporossi, T., Rizzo, S., Guccione, L., Mosca, L., and Scartozzi, L. (2022). Vision Correction and Eye Surgery, BoD\u2013Books on Demand."},{"key":"ref_11","first-page":"14","article-title":"Stabilization period for central corneal thickness, anterior chamber depth, and iridocorneal angle parameters after deep anterior lamellar keratoplasty in keratoconus patients","volume":"6","author":"Durusoy","year":"2021","journal-title":"Beyoglu Eye J."},{"key":"ref_12","first-page":"11206721221144656","article-title":"Analysis of visual and refractive results after wedge resection for high astigmatism after penetrating keratoplasty in keratoconus","volume":"20","author":"Borasio","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_13","first-page":"e939691","article-title":"Prospective Safety Evaluation of the Femtosecond Laser-Assisted Keratomileusis Procedure in Correcting Residual Ametropia in Patients after Deep Anterior Lamellar Keratoplasty","volume":"29","author":"Krysik","year":"2023","journal-title":"Med. Sci. Monit."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Alfonso-Bartolozzi, B., Lisa, C., Fern\u00e1ndez-Vega-Cueto, L., Madrid-Costa, D., and Alfonso, J.F. (2022). Femto-LASIK after Deep Anterior Lamellar Keratoplasty to Correct Residual Astigmatism: A Long-Term Case Series Study. Medicina, 58.","DOI":"10.3390\/medicina58081036"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1097\/ICO.0000000000003110","article-title":"Intrastromal Corneal Ring Segments Implantation after Deep Anterior Lamellar Keratoplasty for Astigmatism Correction: Mid-term and Long-term Follow-up","volume":"42","author":"Lisa","year":"2023","journal-title":"Cornea"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1097\/j.jcrs.0000000000000888","article-title":"Intrastromal corneal ring segments followed by PRK for postkeratoplasty high astigmatism: Prospective study","volume":"48","author":"Bertino","year":"2022","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/ICO.0000000000002403","article-title":"Topography-Guided Photorefractive Keratectomy for Postkeratoplasty Astigmatism: Long-Term Outcomes","volume":"40","author":"Bizrah","year":"2021","journal-title":"Cornea"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/ICO.0000000000002176","article-title":"Long-term Results of Corneal Wedge Resection for High Postkeratoplasty Astigmatism","volume":"39","author":"Gil","year":"2020","journal-title":"Cornea"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10792-017-0803-0","article-title":"Vector analysis of femtosecond laser- assisted astigmatic keratotomy after deep anterior lamellar keratoplasty and penetrating keratoplasty","volume":"39","author":"AnNakhli","year":"2019","journal-title":"Int. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"239","DOI":"10.3928\/1081597X-20190227-01","article-title":"Deep Intrastromal Arcuate Keratotomy with In Situ Keratomileusis (DIAKIK) for theTreatment of High Astigmatism After Keratoplasty: 2-Year Follow-up","volume":"35","author":"Levy","year":"2019","journal-title":"J. Refract. Surg."},{"key":"ref_21","first-page":"1649576","article-title":"Customized Toric Intraocular Lens Implantation in Eyes with Cataract and Corneal Astigmatism after Deep Anterior Lamellar Keratoplasty: A Prospective Study","volume":"2018","author":"Savini","year":"2018","journal-title":"J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8689017","DOI":"10.1155\/2017\/8689017","article-title":"Intrastromal Corneal Ring Segments for Astigmatism Correction after Deep Anterior Lamellar Keratoplasty","volume":"2017","author":"Arantes","year":"2017","journal-title":"J. Ophthalmol."},{"key":"ref_23","first-page":"156","article-title":"Office-based Relaxing Incision Procedure for Correction of Astigmatism after Deep Anterior Lamellar Keratoplasty","volume":"12","author":"Javadi","year":"2017","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.jcrs.2015.12.053","article-title":"Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty","volume":"42","author":"Sharma","year":"2016","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.clae.2014.10.001","article-title":"Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty","volume":"38","author":"Alipour","year":"2015","journal-title":"Contact Lens Anterior Eye."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.ajo.2014.11.033","article-title":"Long-term clinical outcomes of deep anterior lamellar keratoplasty in patients with keratoconus","volume":"159","author":"Romano","year":"2015","journal-title":"Am. J. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1016\/j.jcrs.2014.03.025","article-title":"Effectiveness of cataract phacoemulsification with toric intraocular lenses in addressing astigmatism after keratoplasty","volume":"40","author":"Lockington","year":"2014","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.ajo.2010.10.029","article-title":"Comparison of astigmatic keratotomy results in deep anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus","volume":"151","author":"Kubaloglu","year":"2011","journal-title":"Am. J. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1097\/ICO.0b013e31820686e3","article-title":"Laser-assisted in situ keratomileusis or photorefractive keratectomy after descemet stripping automated endothelial keratoplasty","volume":"30","author":"Ratanasit","year":"2011","journal-title":"Cornea"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1177\/112067211002000406","article-title":"Phacoemulsification after deep anterior lamellar keratoplasty","volume":"20","author":"Leccisotti","year":"2010","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1007\/s00417-015-3091-2","article-title":"Comparison of refractive outcomes in three corneal transplantation techniques for keratoconus","volume":"253","author":"Huang","year":"2015","journal-title":"Graefes. Arch. Clin. Exp. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1097\/ICO.0000000000001688","article-title":"Refractive stability after deep anterior lamellar keratoplasty for keratoconus","volume":"37","author":"Javadi","year":"2018","journal-title":"Cornea"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.clae.2019.12.007","article-title":"A randomised control trial of corneal vs. scleral rigid gas permeable contact lenses for ectatic corneal disorders","volume":"43","author":"Levit","year":"2020","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1097\/ICO.0000000000002131","article-title":"Stepwise combination of femtosecond astigmatic keratotomy with phacoemulsification and toric intraocular lens implantation in treatment of very high postkeratoplasty astigmatism","volume":"39","author":"Sorkin","year":"2020","journal-title":"Cornea"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Liu, H., Chen, Y., Wang, P., Li, B., Wang, W., Su, Y., and Sheng, M. (2015). Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: A meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0113332"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.clae.2016.10.001","article-title":"Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus","volume":"40","author":"Henein","year":"2017","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/ceo.13951","article-title":"Comparison of complications and visual outcomes between big-bubble deep anterior lamellar keratoplasty and penetrating keratoplasty for fungal keratitis","volume":"49","author":"Chen","year":"2021","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.oftal.2014.11.008","article-title":"Comparative study of keratoconus between Anwar\u2019s deep anterior lamellar keratoplasty versus converted penetrating keratoplasty","volume":"90","author":"Donoso","year":"2015","journal-title":"Arch. Soc. Esp. Oftalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/ICO.0000000000000691","article-title":"Deep anterior lamellar keratoplasty versus penetrating keratoplasty: A meta-analysis of randomized controlled trials","volume":"35","author":"Chen","year":"2016","journal-title":"Cornea"},{"key":"ref_40","unstructured":"Quintana, D.S., and Tiebel, J. (2024, May 20). How to Calculate Statistical Power for Your Meta-Analysis. Available online: https:\/\/osf.io\/5c7uz\/."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/11\/3306\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:53:22Z","timestamp":1760108002000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/11\/3306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,4]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13113306"],"URL":"https:\/\/doi.org\/10.3390\/jcm13113306","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,4]]}}}