Predictors Of Receiving Keratoplasty For Fuchs’ Endothelial Corneal Dystrophy Among Medicare Beneficiaries

Published 2022 - 40th Congress of the ESCRS

Reference: PO357 | Type: Free paper | DOI: 10.82333/8vhv-hy11

Authors: Nicolas Heckenlaible ¹ , Chen Dun ² , Christina Prescott* ³ , Allen Eghrari ¹ , Fasika Woreta ¹ , Martin Makary ² , Divya Srikumaran ¹

¹Wilmer Eye Institute,Johns Hopkins University School of Medicine,Baltimore,United States, ²Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,United States, ³NYU Langone Eye Center,NYU Grossman School of Medicine,New York,United States

Purpose

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

Setting

This study was a retrospective review of the United States 100% Medicare fee-for-service administrative claims database between 2011-2019.

Methods

The database was queried for patients ≥65 years holding a diagnosis of FECD. Patients with prior keratoplasty were excluded. A total of 719,066 beneficiaries with FECD were identified, of whom 33,798 (4.7%) went on to receive an EK procedure. A multivariate logistic model including age, race/ethnicity, sex, geography, ocular comorbidities and surgeries, Charlson comorbidity index, and socioeconomic status was used to identify factors associated with receipt of first-time EK. A Kaplan Meier survival analysis was performed to determine the rate of first-time EK after cataract surgery and complex/other anterior segment surgery.

Results

The mean beneficiary age was 76.9 (SD 7.4), 66.0% were female, and 87.9% were white. Factors decreasing likelihood of EK were increasing age [for ≥85, OR=0.62; 95% CI 0.60-0.64], female sex [0.83; 0.81-0.85], Black [0.80; 0.76-0.84], Asian/Pacific Islander [0.61; 0.54-0.68], or Hispanic/Latino [0.70; 0.63-0.79] race and ethnicity compared to White race, Northeast residence [0.82; 0.79-0.84] compared to South, increasing Charlson comorbidity index score [for 7+, 0.51; 0.45-0.58], and history of glaucoma surgery [0.81; 0.77-0.86] or retinal surgery [0.76; 0.73-0.80]. Following cataract or complex/other anterior segment surgery, rates of EK were 1.3% and 4.0% at one year, and 2.5% and 6.8% at eight years, respectively.

Conclusions

This study identifies sex, race and ethnicity, and geography as independent factors associated with receipt of EK for patients with FECD in a multivariable analysis adjusting for age, comorbidity, ocular diagnoses, and ocular surgical history. The probability of receiving EK following cataract surgery is low.