Estimation of the incidence and factors predictive of corneal scarring in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study
Estimation of the incidence and factors predictive of corneal scarring in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study
复制标题
DOI：
10.1097/01.ico.0000164831.87593.08
复制
发表时间：
2006-01-01
期刊：
影响因子：
2.8
通讯作者：
Zadnik, K
中科院分区：
文献类型：
--
作者：
Barr, JT;Wilson, BS;Zadnik, K
目的：圆锥角膜多中心协作纵向评估 (CLEK) 研究是一项针对 1209 名圆锥角膜患者的前瞻性观察性研究。我们报告了定义角膜瘢痕事件的方法以及预测 CLEK 研究圆锥角膜患者非手术眼角膜瘢痕事件第五年随访的基线因素。 方法：在 1209 名患者中，878 名在基线时至少有一个无疤痕角膜的患者被纳入本研究。 5 年累计疤痕发生率定义为出现中央角膜混浊的患者比例，由临床医生使用裂隙灯生物显微镜检查患者并在 CLEK 摄影阅读中心对角膜照片进行遮蔽读数来检测。使用逻辑回归分析来测试基线因素与角膜疤痕事件之间的关系。分析的基线因素包括年龄、性别、种族、特应性疾病、隐形眼镜佩戴情况、圆锥角膜家族史、角膜曲率和中央角膜荧光素染色等。 结果：角膜疤痕的 5 年发生率为 13.7%（878 只眼睛中的 120 只），佩戴隐形眼镜的眼睛为 16.7%（609 只眼睛中的 102 只），38.0%（609 只眼睛中的 46 只）。 121）对于角膜曲率大于 52 D 的佩戴隐形眼镜的眼睛。预测疤痕形成的基线因素包括角膜曲率大于 52 D（比值比 [OR] = 4.79；95% 置信区间 [CI]，3.08，7.45；P < 0.001）、隐形眼镜佩戴（OR = 2.50；95% CI，1.40，4.76；P < 0.001）。 P = 0.003），明显的角膜染色（OR = 2.38；95% CI，1.49，3.76；P = 0.0002），年龄小于 20 岁（OR = 6.34；95% CI，2.57，15.00；P < 0.0001）。 结论：对 5 年前瞻性数据进行多变量分析CLEK 研究队列显示，基线角膜曲率、隐形眼镜佩戴情况、角膜染色和年轻年龄可预测角膜疤痕的发生。总体样本的 5 年疤痕发生率为 13.7%，佩戴隐形眼镜的角膜曲率大于 52 D 的眼睛的 5 年疤痕发生率为 38.0%。佩戴隐形眼镜会使疤痕形成的风险增加两倍以上。这些发现表明佩戴隐形眼镜与圆锥角膜角膜疤痕形成有因果关系，并暗示可以通过改变隐形眼镜贴合度来减少角膜疤痕形成。
Purpose: The multicenter Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study is a prospective, observational study of 1209 keratoconus patients. We report methods to define incident corneal scarring and baseline factors predictive of incident corneal scarring in nonsurgical eyes of CLEK Study keratoconus patients through their fifth year of follow-up.Methods: Of the 1209 patients, 878 patients with at least one unscarred cornea at baseline were included in this study. The cumulative 5-year incidence of scarring is defined as the proportion of patients who developed central corneal opacification as detected by a clinician examining the patient with a slit-lamp biomicroscope and by masked readings of corneal photographs at the CLEK Photography Reading Center. Logistic regression analysis was used to test for relationships between baseline factors and incident corneal scarring. Baseline factors analyzed included age, sex, race, atopic disease, contact lens wear, family history of keratoconus, corneal curvature, and central corneal fluorescein staining, among others.Results: The 5-year incidence of corneal scarring was 13.7% (120 of 878) overall, 16.7% (102 of 609) for contact lens-wearing eyes, and 38.0% (46 of 121) for contact lens-wearing eyes with corneal curvature greater than 52 D. Baseline factors predictive of incident scarring included corneal curvature greater than 52 D (odds ratio [OR] = 4.79; 95% confidence interval [CI], 3.08, 7.45; P < 0.001), contact lens wear (OR = 2.50; 95% CI, 1.40, 4.76; P = 0.003), marked corneal staining (OR = 2.38; 95% CI, 1.49, 3.76; P = 0.0002), and age less than 20 years (OR = 6.34; 95% CI, 2.57, 15.00; P < 0.0001).Conclusions: Multivariate analyses of 5-year prospective data from the CLEK Study cohort showed that baseline corneal curvature, contact lens wear, corneal staining, and younger age were predictive of the development of corneal scarring. The 5-year incidence of scarring is 13.7% for the overall sample and 38.0% for those eyes with corneal curvature greater than 52 D that wore contact lenses. Contact lens wear increased the risk of incident scarring more than 2-fold. These findings suggest a causal contribution of contact lens wear to corneal scarring in keratoconus and imply that corneal scarring might be reduced by modifying the contact lens fit.