LAUSR

PURPOSE To identify sociodemographic factors and comorbid conditions associated with receiving keratoplasty for keratoconus (KCN) DESIGN: Retrospective, cross-sectional study METHODS: Health records of KCN patients aged <65 years from 2011 to 2018 were obtained from the IBM MarketScan Database. A multivariable model adjusted for potential confounders was used to examine factors associated with the risk of receiving keratoplasty. RESULTS Of 42,086 total KCN patients identified, 1,282 (3.0%) patients had keratoplasty to treat KCN. In the fully adjusted analysis, female sex (OR=0.87 [95% CI=0.78-0.98]) and living in metropolitan areas (OR=0.75 [0.63-0.90]) were associated with lower odds of receiving keratoplasty. Compared to individuals aged 10-19 years, those aged 20-29 (OR=1.77 [1.31-2.41]) and 30-39 (OR=1.61 [1.19-2.17]) were more likely to have keratoplasty, while individuals in the older age groups (50-64) did not show statistically significant associations. Conditions associated with higher odds of receiving keratoplasty were corneal hydrops (OR=4.87 [4.07-5.82]), Leber congenital amaurosis (OR=2.41 [1.02-5.71]), sleep apnea (OR=1.46 [1.25-1.71]), diabetes mellitus (OR=1.32 [1.13-1.54]), and depression (OR=1.22 [1.03-1.44]). Conditions associated with lower odds were prior contact lens usage (OR=0.61 [0.50-0.74]) and a history of glaucoma (OR=0.60 [0.49-0.73]). CONCLUSIONS This analysis of a large sample of KCN patients reveals previously unidentified risk factors associated with receiving keratoplasty including Leber congenital amaurosis, depression, and diabetes. Future research should examine if young patients with these conditions may benefit from more frequent follow-up and/or early crosslinking to reduce the need for subsequent keratoplasty.