Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Cornea. 2021 Jan;40(1):39-42. doi: 10.1097/ICO.0000000000002388.
To evaluate the association of scleral contact lens (SCL) use on the risk for keratoplasty for people with keratoconus.
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 keratoconus or corneal ectasia, no previous history of keratoplasty, and for whom data were available for both eyes were included. Using a multivariable Cox regression model, associations between SCL use and keratoplasty were tested and adjusted for sociodemographic factors, maximum keratometry, and current contact lens (CL) use.
Two thousand eight hundred six eyes met the 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% confidence interval [CI] 0.09-0.39, P < 0.0001 and HR = 0.30, 95% CI 0.17-0.52, P < 0.0001, respectively) when compared with 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 the Area Deprivation Index, 95% CI 1.03-1.13, P = 0.0008). Keratoplasty was not associated with sex, insurance, or maximum keratometry.
Physicians should maximize the use of scleral or RGP CL because patients who successfully use CL have almost one-fifth the risk of undergoing keratoplasty.
评估巩膜接触镜（SCL）的使用与圆锥角膜患者行角膜移植术风险之间的关联。
回顾 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部护理的患者的电子健康记录。纳入具有圆锥角膜或角膜扩张症诊断代码、无既往角膜移植史且双眼均有数据的患者。使用多变量 Cox 回归模型，测试 SCL 使用与角膜移植之间的关联，并调整了社会人口因素、最大角膜曲率和当前接触镜（CL）使用情况。
符合纳入标准的有 2860 只眼。每只眼的 CL 使用情况为无 CL 者占 36.2%，软性 CL 者占 7.2%，硬性透气性角膜接触镜（RGP）者占 33.9%，巩膜 CL 者占 22.7%。共有 3.2%的眼接受了角膜移植。在调整后的模型中，与不使用 CL 相比，SCL 或 RGP CL 的使用显著降低了接受角膜移植的风险（HR=0.19，95%置信区间 [CI]0.09-0.39，P<0.0001 和 HR=0.30，95%CI0.17-0.52，P<0.0001）。与角膜移植风险增加相关的因素包括与白人相比的黑人种族（HR=1.87，95%CI1.10-3.16，P=0.02）、年龄较小（HR=每 5 岁增加 0.92，95%CI0.86-0.99，P=0.032）和较低的社会经济地位（HR=区域剥夺指数每增加 5 分增加 1.08，95%CI1.03-1.13，P=0.0008）。角膜移植与性别、保险或最大角膜曲率无关。
医生应最大限度地使用巩膜或 RGP CL，因为成功使用 CL 的患者行角膜移植的风险几乎降低了五分之一。
