PURPOSE To evaluate the association of scleral contact lens (SCL) use on the risk for keratoplasty for people with keratoconus. METHODS The electronic health records of patients receiving eye care at the University of Michigan Kellogg Eye Center between August 1, 2012, and December 31, 2018, were reviewed. Patients with a diagnostic code of keratoconus or corneal ectasia, no previous history of keratoplasty, and for whom data were available for both eyes were included. Using a multivariable Cox regression model, associations between SCL use and keratoplasty were tested and adjusted for sociodemographic factors, maximum keratometry, and current contact lens (CL) use. RESULTS Two thousand eight hundred six eyes met the inclusion criteria. CL use in each eye was 36.2% with no CL, 7.2% soft, 33.9% rigid gas permeable (RGP), and 22.7% scleral. A total of 3.2% of eyes underwent keratoplasty. In the adjusted model, SCL or RGP CL use significantly lowered the hazard of undergoing keratoplasty (HR = 0.19, 95% confidence interval [CI] 0.09-0.39, P < 0.0001 and HR = 0.30, 95% CI 0.17-0.52, P < 0.0001, respectively) when compared with no CL use. Factors associated with increased risk of keratoplasty were black race as compared to white (HR = 1.87, 95% CI 1.10-3.16, P = 0.02), younger age (HR = 0.92 per 5-year increment, 95% CI 0.86-0.99, P = 0.032), and lower socioeconomic status (HR = 1.08 per 5-point increase in the Area Deprivation Index, 95% CI 1.03-1.13, P = 0.0008). Keratoplasty was not associated with sex, insurance, or maximum keratometry. CONCLUSIONS Physicians should maximize the use of scleral or RGP CL because patients who successfully use CL have almost one-fifth the risk of undergoing keratoplasty.

中文翻译：

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巩膜隐形眼镜的使用对圆锥角膜角膜移植率的影响。

目的 评估巩膜接触镜 (SCL) 使用与圆锥角膜患者角膜移植术风险之间的关系。方法对2012年8月1日至2018年12月31日期间在密歇根大学凯洛格眼科中心接受眼科护理的患者的电子健康记录进行了审查。诊断代码为圆锥角膜或角膜扩张、既往无角膜移植史且双眼数据均可用的患者均纳入其中。使用多变量 Cox 回归模型，测试了 SCL 使用与角膜移植术之间的关联，并根据社会人口学因素、最大角膜曲率测量和当前隐形眼镜 (CL) 使用进行了调整。结果 2806只眼睛符合纳入标准。每只眼睛使用 CL 的比例分别为 36.2%（无 CL）、7.2% 的软性、33.9% 的刚性透气性 (RGP) 和 22.7% 的巩膜。共有3.2%的眼睛接受了角膜移植术。在调整后的模型中，使用 SCL 或 RGP CL 显着降低了进行角膜移植术的风险（HR = 0.19，95% 置信区间 [CI] 0.09-0.39，P < 0.0001，HR = 0.30，95% CI 0.17-0.52，P < 0.0001）与不使用 CL 相比。与白种人相比，与角膜移植术风险增加相关的因素包括黑人种族（HR = 1.87，95% CI 1.10-3.16，P = 0.02）、年龄较小（HR = 每 5 年增量 0.92，95% CI 0.86-0.99， P = 0.032），以及较低的社会经济地位（区域剥夺指数每增加 5 点，HR = 1.08，95% CI 1.03-1.13，P = 0.0008）。角膜移植术与性别、保险或最大角膜曲率无关。结论 医生应最大限度地使用巩膜或 RGP CL，因为成功使用 CL 的患者接受角膜移植术的风险几乎是五分之一。