Heckenlaible Nicolas J, Dun Chen, Prescott Christina, Eghrari Allen O, Woreta Fasika, Makary Martin A, Srikumaran Divya
The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmology. 2023 Jan;130(1):28-38. doi: 10.1016/j.ophtha.2022.07.030. Epub 2022 Aug 3.
To identify factors associated with receipt of endothelial keratoplasty (EK) and penetrating keratoplasty (PK) in patients with Fuchs' endothelial corneal dystrophy (FECD).
Retrospective cohort study.
Medicare beneficiaries 65 years of age or older with a FECD diagnosis between 2011 and 2019.
The 100% Medicare fee-for-service administrative claims database was queried for treatment-naïve FECD patients. A multivariate logistic regression model including age, race and ethnicity, sex, geography, ocular comorbidities and surgeries, Charlson comorbidity index (CCI), and socioeconomic status was used to identify factors associated with receipt of EK and PK. Kaplan-Meier survival analyses were used to determine the rate of EK after cataract or complex or other anterior segment surgery.
Factors associated with receipt of an EK or PK, plus rate of EK after cataract or complex or other anterior segment surgery.
Of 719 066 beneficiaries identified, 31 372 (4.4%) received an EK and 2426 (0.3%) received a PK. In a multivariate analysis, female sex decreased likelihood of both EK and PK (adjusted odds ratio 0.83 [95% confidence interval 0.81-0.85] and 0.84 [0.78-0.92], respectively), while Western residence (1.33 [1.29-1.38]; 1.25 [1.11-1.42]) compared to Southern and history of complex or other anterior segment surgery (1.62 [1.54-1.70]; 5.52 [4.97-6.12]) increased the likelihood of both. Compared to Whites, the likelihood of EK was decreased for Black (0.76 [0.72-0.80]), Asian or Pacific Islander (0.54 [0.48-0.61]), and Hispanic or Latino (0.62 [0.55-0.70]) race and ethnicity, while for the same groups likelihood of PK was increased (for Black 1.32 [1.14-1.53]; Asian/Pacific Islander 1.46 [1.13-1.89]; and Hispanic/Latino 1.62 [1.25-2.11]). Following cataract or complex/other anterior segment surgery, rates of EK were 1.3% and 3.3% at 1 year and 2.3% and 5.6% at 8 years, respectively.
In a multivariate analysis, women beneficiaries are less likely to receive EK or PK for FECD compared with men, whereas non-White beneficiaries are less likely to receive EK and more likely to receive PK compared with White beneficiaries.
确定与富克斯内皮性角膜营养不良（FECD）患者接受内皮角膜移植术（EK）和穿透性角膜移植术（PK）相关的因素。
回顾性队列研究。
2011年至2019年间诊断为FECD的65岁及以上医疗保险受益人。
查询100%医疗保险按服务收费行政索赔数据库中未接受过治疗的FECD患者。使用多变量逻辑回归模型，包括年龄、种族和民族、性别、地理位置、眼部合并症和手术、查尔森合并症指数（CCI）以及社会经济地位，以确定与接受EK和PK相关的因素。采用Kaplan-Meier生存分析来确定白内障或复杂或其他前段手术后EK的发生率。
与接受EK或PK相关的因素，以及白内障或复杂或其他前段手术后EK的发生率。
在719066名确定的受益人中，31372人（4.4%）接受了EK，2426人（0.3%）接受了PK。在多变量分析中，女性接受EK和PK的可能性均降低（调整后的优势比分别为0.83[95%置信区间0.81-0.85]和0.84[0.78-0.92]），而与南方相比，居住在西部（1.33[1.29-1.38]；1.25[1.11-1.42]）以及有复杂或其他前段手术史（1.62[1.54-1.70]；5.52[4.97-6.12]）会增加接受这两种手术的可能性。与白人相比，黑人（0.76[0.72-0.80]）、亚洲或太平洋岛民（0.54[0.48-0.61]）以及西班牙裔或拉丁裔（0.62[0.55-0.70]）种族和民族接受EK的可能性降低，而对于相同群体，接受PK的可能性增加（黑人1.32[1.14-1.53]；亚洲/太平洋岛民1.46[1.13-1.89]；西班牙裔/拉丁裔1.62[1.25-2.11]）。白内障或复杂/其他前段手术后，1年时EK的发生率分别为1.3%和3.3%，8年时分别为2.3%和5.6%。
在多变量分析中，与男性相比，女性受益人因FECD接受EK或PK的可能性较小，而非白人受益人与白人受益人相比，接受EK的可能性较小，接受PK的可能性较大。
