Purpose

To identify factors associated with receipt of endothelial keratoplasty (EK) and penetrating keratoplasty (PK) in patients with Fuchs’ endothelial corneal dystrophy (FECD).

Design

Retrospective cohort study.

Participants

Medicare beneficiaries 65 years of age or older with a FECD diagnosis between 2011 and 2019.

Methods

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.

Main Outcome Measures

Factors associated with receipt of an EK or PK, plus rate of EK after cataract or complex or other anterior segment surgery.

Results

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.

Conclusions

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.

中文翻译：

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在医疗保险受益人中接受角膜移植术治疗 Fuchs 角膜内皮营养不良的预测因素

目的

确定与 Fuchs角膜内皮营养不良 (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。

设计

回顾性队列研究。

参加者

2011 年至 2019 年间被诊断为 FECD 的 65 岁或以上的 Medicare 受益人。

方法

查询了 100% Medicare 按服务收费的行政索赔数据库，以查找未接受过治疗的 FECD 患者。包括年龄、种族和民族、性别、地理、眼部合并症和手术、Charlson 合并症指数(CCI) 和社会经济地位在内的多变量逻辑回归模型用于确定与接受 EK 和 PK 相关的因素。Kaplan-Meier 生存分析用于确定白内障或复杂或其他眼前节手术后的 EK 率。

主要观察指标

与接受 EK 或 PK 相关的因素，加上白内障或复杂或其他眼前节手术后的 EK 率。

结果

在确定的 719 066 名受益人中，31 372 名（4.4%）获得了 EK，2426 名（0.3%）获得了 PK。在多变量分析中，女性降低了 EK 和 PK 的可能性（调整后的比值比分别为 0.83 [95% 置信区间 0.81–0.85] 和 0.84 [0.78–0.92]），而居住在西方的女性（1.33 [1.29–1.38]； 1.25 [1.11-1.42]) 与 Southern 和复杂或其他眼前节手术史 (1.62 [1.54-1.70]; 5.52 [4.97-6.12]) 相比增加了两者的可能性。与白人相比，黑人 (0.76 [0.72–0.80])、亚裔或太平洋岛民 (0.54 [0.48–0.61]) 和西班牙裔或拉丁裔 (0.62 [0.55–0.70]) 种族和民族发生 EK 的可能性降低，而对于同一组，PK 的可能性增加了（黑人 1.32 [1.14–1.53]；亚裔/太平洋岛民 1.46 [1.13–1.89]；西班牙裔/拉丁裔 1.62 [1.25–2.11]）。

结论

在多变量分析中，与男性相比，女性受益人接受 FECD 的 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，而接受 PK 的可能性更大。