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Trends in Corneal Transplantation in Keratoconus

Sarezky, Daniel MD; Orlin, Stephen E. MD; Pan, Wei MS; VanderBeek, Brian L. MD, MPH, MSCE

doi: 10.1097/ICO.0000000000001083
Clinical Science

Purpose: To determine recent trends in and sociodemographic/comorbid conditions associated with penetrating keratoplasty (PK) and lamellar keratoplasty (LK) for keratoconus (KCN).

Methods: Patients with KCN and subsequent PK and LK procedures were identified using International Classification of Diseases, 9th revision (ICD-9) and Current Procedural Terminology (CPT) billing codes. The change in surgical rates was calculated over a decade, and multivariate analysis demonstrated factors associated with undergoing surgery.

Results: A total of 21,588 patients with KCN underwent 1306 PK procedures and 109 LK procedures during the study period. Individuals were significantly less likely to undergo PK from 2009 to 2012 compared with 2001 to 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 to 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's degree or only a high school diploma (OR 1.94–2.84, P < 0.001 for all comparisons). Female sex (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 decreased odds of PK. No significant associations for LK were observed.

Conclusions: The rate of PK in KCN is decreasing in the United States. The third or fourth decade of life, male sex, black race, lower education, and greater household net worth are associated with increased odds of PK.

*Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA;

Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA;

Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and

§Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Reprints: Brian L. VanderBeek, MD, MPH, MSCE, Scheie Eye Institute, 51 North 39th St, Philadelphia, PA 19104 (e-mail:

Supported by National Institutes of Health K23 Award (1K23EY025729-01) and University of Pennsylvania Core Grant for Vision Research (2P30EY001583-41). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by Research to Prevent Blindness and the Paul and Evanina Mackall Foundation. Funding from each of the above sources was received in the form of block research grants to the Scheie Eye Institute. None of the organizations had any role in the design or conduction of the study.

The authors have no conflicts of interest to disclose.

Portions of the data used in this study were presented at the American Academy of Ophthalmology Annual Meeting, Chicago, IL, October 16, 2016.

Received June 17, 2016

Received in revised form September 30, 2016

Accepted October 4, 2016

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