Trends in Corneal Transplantation in Keratoconus

Abstract

Purpose To determine recent trends for and sociodemographic/comorbid conditions associated with penetrating (PK) and lamellar keratoplasties (LK) in keratoconus (KCN). Methods KCN patients and subsequent PK and LK procedures were identified using ICD-9 and CPT billing codes. The change in surgical rates was calculated over a decade and multivariate analysis demonstrated factors associated with having surgery. Results 21588 KCN patients had 1306 PK’s and 109 LK’s during the study period. Individuals were significantly less likely to undergo PK from 2009–2012 compared to 2001–2008 (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.47–0.68, p <0.001). Multivariate analysis revealed the factors that increased the likelihood of PK alone and included age 20–40 (OR 1.90, 95% CI 1.19–3.04, p <0.001), black race (OR 1.36, 95% CI 1.06–1.74, p = 0.01), and education less than a bachelor degree or a high school diploma only (OR 1.94–2.84, p <0.001 for all comparisons). Female gender (OR 0.74, 95% CI 0.63–0.88, p <0.001) and household net worth either between 150 and 249K (OR 0.64, 95% CI 0.48–0.84, p <0.001) or more than $500,000 (OR 0.71, 95% CI 0.51–0.99, p = 0.03) were traits associated with a decreased odds of PK. No significant associations for LK were observed. Conclusion The rate of PK in KCN is decreasing in the United States. The 3rd or 4th decade of life, male gender, black race, lower education, and greater household net worth are associated with increased odds of PK.

Matrix metalloproteinases in keratoconus – Too much of a good thing?

“…However, some patients eventually require a corneal transplant 4 and KC is still one of the most common indications for keratoplasty worldwide [5][6][7] , although the frequency of corneal transplantations for KC patients is declining in some countries 8 . As the average age at onset of the disease is in early adulthood 9 , KC has a long term impact on the quality of life of patients.…”

Noninvasive Assessment of Corneal Crosslinking With Phase-Decorrelation Optical Coherence Tomography

“…Corneal ectasia causes impaired quality of life1 and is a leading indication for corneal transplantation 2. Keratoconus, the most common form of corneal ectasia, affects approximately 1 in 375 individuals3 and has a predilection for progression in the second and third decades of life 4.…”

Biomechanical and morphological changes of rabbit corneas under collagenase type II and negative pressure: three months follow-up observation

“…Corneal ectasia results in a decline in the quality of life [19] , and it is a leading indication for keratoplasty [20] . Corneal ectasia animal models can be used to explore In CII group, an increase of 4.38D in mean value of D_H, and decrease of CCT and CH were shown in experimental corneas 2 weeks after treatment, which is consistent with the clinical manifestations of corneal ectasia, and also consistent with Yan's result [15] .…”