Kanu Levi N, Boychev Nikolay, Fry Meredith, Margolis Leah, Le Cherry, Paneru Rimsha, Ng Veronica, Hutchison Jules, Ciolino Joseph B
Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2025 Jun 4;20(6):e0319132. doi: 10.1371/journal.pone.0319132. eCollection 2025.
To determine whether sociodemographic factors affect the outcomes of patients with unstable keratoconus.
Retrospective case control study.
All patients diagnosed with unstable keratoconus at Mass Eye and Ear between January 2016 and October 2022. Those who experienced acute corneal hydrops during the study period were considered cases, and those who did not were considered controls.
Potential subjects were identified by billing code and verified with review of clinical documentation. Charts were reviewed for pertinent sociodemographic, medical, and ocular risk factors.
Clinical diagnosis of acute corneal hydrops was the primary outcome. Receipt of corneal crosslinking (CXL) was a secondary outcome.
Of 762 patients diagnosed with unstable keratoconus, we identified 128 episodes of hydrops in 113 patients (14.9%). Compared to controls, cases were a significantly higher proportion Black (27.6% vs 14.6%, P < 0.0001), unemployed (22.4% vs 12.5%, P < 0.01), and/or covered by public health insurance plans (50.4% vs 27.7%, P < 0.0001). Body mass index (BMI) was significantly higher in cases (34.1 ± 10.0) than controls (29.2 ± 8.1, mean±SD, P < 0.0001). Developmental delay (17.7% vs 3.4%, P < 0.0001), atopy (48.9% vs 30.4%, P = 0.0001), sleep apnea (9.7% vs 1.2%, P < 0.0001), and eye rubbing (85.5% vs 67.7%, P < 0.01) were all more common in the hydrops group. In a stepwise multivariable logistic regression analysis, Black race [2.10 (1.02-4.27), P = 0.041], public health insurance coverage [2.06 (1.12-3.80), P = 0.020], BMI [1.05 (1.02-1.08), P = 0.003], and developmental delay [16.42 (5.62-56.30), P < 0.001] were each associated with a higher odds of incident hydrops [OR (95%CI)]. Similar trends were found to influence the receipt of CXL, with male sex [0.34 (0.13-0.77), P = 0.015], Black race [0.39 (0.16-0.97), P = 0.038], and public health insurance [0.37 (0.16-0.82), P = 0.014] negatively influencing the odds of receiving CXL.
This study establishes several sociodemographic (Black race, unemployment, and publicly insured) and medical (high BMI and developmental delay) factors as independent risk factors influencing the incidence of hydrops and/or the receipt of CXL in a large group of patients with unstable keratoconus. Special attention is warranted when caring for patients within these subpopulations with unstable keratoconus, and further study into the mechanisms of these associations is warranted.
确定社会人口统计学因素是否会影响圆锥角膜病情不稳定患者的治疗结果。
回顾性病例对照研究。
2016年1月至2022年10月期间在麻省眼耳医院被诊断为圆锥角膜病情不稳定的所有患者。在研究期间经历急性角膜水肿的患者被视为病例组，未经历的患者被视为对照组。
通过计费代码识别潜在研究对象，并通过查阅临床文档进行核实。查阅病历以获取相关的社会人口统计学、医学和眼部危险因素。
急性角膜水肿的临床诊断为主要观察指标。接受角膜交联术（CXL）为次要观察指标。
在762例被诊断为圆锥角膜病情不稳定的患者中，我们在113例患者（14.9%）中发现了128次角膜水肿发作。与对照组相比，病例组中黑人比例显著更高（27.6%对14.6%，P<0.0001）、失业者比例更高（22.4%对12.5%，P<0.01）以及/或者参加公共医疗保险计划的比例更高（50.4%对27.7%，P<0.0001）。病例组的体重指数（BMI）显著高于对照组（34.1±10.0对29.2±8.1，均值±标准差，P<0.0001）。发育迟缓（17.7%对3.4%，P<0.0001）、特应性（48.9%对30.4%，P = 0.0001）、睡眠呼吸暂停（9.7%对1.2%，P<0.0001）以及揉眼（85.5%对67.7%，P<0.01）在角膜水肿组中均更为常见。在逐步多变量逻辑回归分析中，黑人种族[2.10（1.02 - 4.27），P = 0.041]、公共医疗保险覆盖[2.06（1.12 - 3.80），P = 0.020]、BMI[1.05（1.02 - 1.08），P = 0.003]以及发育迟缓[16.42（5.62 - 56.30），P<0.001]均与角膜水肿发病几率较高相关[比值比（95%置信区间）]。发现类似趋势影响CXL的接受情况，男性[0.34（0.13 - 0.77），P = 0.015]、黑人种族[0.39（0.16 - 0.97），P = 0.038]以及公共医疗保险[0.37（0.16 - 0.82），P = 0.014]对接受CXL的几率有负面影响。
本研究确定了几个社会人口统计学因素（黑人种族、失业和参加公共医疗保险）和医学因素（高BMI和发育迟缓）为影响一大群圆锥角膜病情不稳定患者角膜水肿发生率和/或接受CXL情况的独立危险因素。在照顾这些圆锥角膜病情不稳定亚组患者时需要特别关注，并且有必要进一步研究这些关联的机制。
