Impact of Scleral Contact Lens Use on the Rate of Corneal Transplantation for Keratoconus.
Impact of Scleral Contact Lens Use on the Rate of Corneal Transplantation for Keratoconus.
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DOI：
10.1097/ico.0000000000002388
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发表时间：
2021-01
期刊：
影响因子：
2.8
通讯作者：
Woodward MA
中科院分区：
文献类型：
--
作者：
Ling JJ;Mian SI;Stein JD;Rahman M;Poliskey J;Woodward MA
评价圆锥角膜（KCN）患者使用巩膜接触透镜（SCL）与角膜移植术风险的关系。审查了2012年8月1日至2018年12月31日期间在密歇根大学凯洛格眼科中心接受眼科护理的患者的电子健康记录。纳入诊断代码为KCN或角膜扩张、既往无角膜移植术史且双眼数据可用的患者。使用多变量考克斯回归模型，校正社会人口学因素、最大角膜曲率（MaxK）和当前接触透镜（CL）使用情况，检验SCL使用与角膜移植术之间的关联。2，806只眼符合入选标准。每只眼睛中CL的使用率为36.2%，无CL，7.2%为软性，33.9%为硬性透气性（RGP），22.7%为巩膜。共有3.2%的眼睛接受了角膜移植术。在调整后的模型中，与不使用CL相比，使用SCL或RGP CL显著降低了接受角膜移植术的风险（HR=0.19，95% CI 0.09-0.39，p<0.0001和HR=0.30，95% CI 0.17-0.52，p<0.0001）。与白色人种相比，与角膜移植术风险增加相关的因素是黑人（HR=1.87，95% CI 1.10-3.16，p=0.02），年龄较小（HR=0.92/5年增量，95% CI 0.86-0.99，p=0.032），社会经济地位较低（地区贫困指数每增加5个点，HR=1.08，95%CI 1.03-1.13，p=0.0008）。角膜移植术与性别、保险或MaxK无关。医生应最大限度地使用巩膜或RGP CL，因为成功使用CL的患者几乎有五分之一的风险接受角膜移植术。
To evaluate the association of scleral contact lens (SCL) use on the risk for keratoplasty for people with keratoconus (KCN). The electronic health records of patients receiving eye care at the University of Michigan Kellogg Eye Center between August 1, 2012 and December 31, 2018 were reviewed. Patients with a diagnostic code of KCN or corneal ectasia, no previous history of keratoplasty, and for whom data was available for both eyes were included. Using a multivariable Cox regression model, associations between SCL use and keratoplasty were tested adjusted for sociodemographic factors, maximum keratometry (MaxK), and current contact lens (CL) use. 2,806 eyes met inclusion criteria. CL use in each eye was 36.2% with no CL, 7.2% soft, 33.9% rigid gas permeable (RGP), and 22.7% scleral. A total of 3.2% of eyes underwent keratoplasty. In the adjusted model, SCL or RGP CL use significantly lowered the hazard of undergoing keratoplasty (HR=0.19, 95% CI 0.09-0.39, p<0.0001 and HR=0.30, 95% CI 0.17-0.52, p<0.0001, respectively), when compared to no CL use. Factors associated with increased risk of keratoplasty were black race as compared to white (HR=1.87, 95% CI 1.10-3.16, p=0.02), younger age (HR=0.92 per 5-year increment, 95% CI 0.86-0.99, p=0.032), and lower socioeconomic status (HR=1.08 per 5-point increase in Area Deprivation Index, 95% CI 1.03-1.13, p=0.0008). Keratoplasty was not associated with gender, insurance, or MaxK. Physicians should maximize the use of scleral or RGP CL as patients who successfully use CL have almost one fifth risk of undergoing keratoplasty.