Kong Alan W, Ahmad Tessnim R, Turner Marcus L, Barnett Jackson, Kaur Gurbani, Pasricha Neel D, Indaram Maanasa
School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
Clin Ophthalmol. 2022 Apr 28;16:1357-1363. doi: 10.2147/OPTH.S361352. eCollection 2022.
To describe trends in the use of corneal topography and tomography for the management of keratoconus patients at a single academic institution and to identify how these trends may be associated with different procedural interventions.
In this retrospective cohort study, keratoconus patients treated from 2012 to 2019 were identified. The electronic health record was reviewed for the presence of corneal topography or tomography imaging completed within seven days of the first visit and the highest level of intervention at the first and most recent visit. Patients were grouped as pediatric (<18 years) or adult (≥18 years). Chi-square tests and linear regressions were used to evaluate trends and to determine which factors were predictive for receiving corneal collagen cross-linking (CXL) versus other surgical interventions (intrastromal corneal ring segments, lamellar keratoplasty, or penetrating keratoplasty) by the most recent visit.
A total of 873 keratoconus patients met inclusion criteria. The use of corneal topography at the first visit remained relatively consistent from 2012 to 2019, while corneal tomography usage at the first visit increased from 3.9% in 2015, when corneal tomography was introduced, to 52.8% in 2019. Each year was associated with an 11.2% ± 1.9% increase in the use of corneal tomography at the first visit in pediatric patients and 6.7% ± 0.5% in adult patients. Use of corneal tomography at the first visit was a significant predictor for receiving CXL procedures (P < 0.001) and a negative predictor for requiring other surgical interventions (P = 0.032) when controlling for the year of the first visit.
Obtaining corneal tomography at the first visit has become the standard of care in keratoconus, especially for pediatric patients. Moreover, the increase in corneal tomography imaging has coincided with an increase in CXL procedures and decrease in other surgical interventions.
描述在单一学术机构中使用角膜地形图和断层扫描来管理圆锥角膜患者的趋势，并确定这些趋势如何与不同的手术干预相关。
在这项回顾性队列研究中，确定了2012年至2019年接受治疗的圆锥角膜患者。查阅电子健康记录，以确定首次就诊7天内完成的角膜地形图或断层扫描成像情况，以及首次和最近一次就诊时的最高干预级别。患者分为儿童（<18岁）或成人（≥18岁）。使用卡方检验和线性回归来评估趋势，并确定哪些因素可预测在最近一次就诊时接受角膜胶原交联（CXL）与其他手术干预（角膜基质内环形片段、板层角膜移植术或穿透性角膜移植术）。
共有873例圆锥角膜患者符合纳入标准。2012年至2019年，首次就诊时角膜地形图的使用相对稳定，而首次就诊时角膜断层扫描的使用从2015年引入角膜断层扫描时的3.9%增加到2019年的52.8%。每年儿童患者首次就诊时角膜断层扫描的使用增加11.2%±1.9%，成人患者增加6.7%±0.5%。在控制首次就诊年份时，首次就诊时使用角膜断层扫描是接受CXL手术的显著预测因素（P<0.001），也是需要其他手术干预的负向预测因素（P=0.032）。
首次就诊时进行角膜断层扫描已成为圆锥角膜的标准治疗方法，尤其是对于儿童患者。此外，角膜断层扫描成像的增加与CXL手术的增加以及其他手术干预的减少相吻合。
