Factors Associated With Keratoplasty Among Patients With Keratoconus: A Nationwide Cohort Study
Published 2025 - 43rd Congress of the ESCRS
Reference: PP14.18 | Type: Poster | DOI: 10.82333/8xpv-4419
Authors: Yu-Yen Chen* 1 , Hui-Yu Wang 2 , Chia-Hsuan Tsai 3
1Department of Ophthalmology,Taichung Veterans General Hospital,Taichung,Taiwan, Province of China;National Chung Hsing University,Doctoral Program in Translational Medicine,Taichung,Taiwan, Province of China;Student, Biomedical Informatics & Data Science (BIDS) Section, Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,United States, 2Department of Medical Education,Taichung Veterans General Hospital, Taichung,Taichung,Taiwan, Province of China;School of Medicine,National Yang Ming Chiao Tung University,Taipei,Taiwan, Province of China, 3Department of Medical Education,Taichung Veterans General Hospital,Taichung,Taiwan, Province of China;School of Medicine,Chung Shan Medical University,Taichung,Taiwan, Province of China
Purpose
This study aimed to analyze trends and identify demographic and clinical risk factors associated with receiving keratoplasty for keratoconus in Taiwan.
Setting
A retrospective, population-based cohort study using data from the Taiwan National Health Insurance Research Database (NHIRD).
Methods
Patients diagnosed with new-onset keratoconus from 2008 to 2020 were identified in the NHIRD. Demographic and clinical characteristics were compared between patients who underwent keratoplasty and those who did not using the Chi-square test. A multivariable Cox regression model was applied to estimate adjusted hazard ratios (HRs) for keratoplasty, incorporating variables such as age, sex, socioeconomic status (urbanization level, income), diabetes, sleep apnea, depression, Down syndrome, atopic disease, glaucoma, and acute hydrops.
Results
Among 10,872 keratoconus patients, 370 underwent keratoplasty. The number of keratoplasty procedures decreased over the study period. Patients receiving keratoplasty were significantly younger and more likely to be male. In multivariable Cox regression, significant risk factors for keratoplasty included young age (20-30 years old) (HR 1.46; 95% confidence interval [CI] 1.15-1.85), male sex (HR 2.78; 95% CI 2.17–3.55), depression (HR 1.95; 95% CI 1.43–2.67), Down syndrome (HR 5.12; 95% CI 1.33–13.22), and acute hydrops (HR 5.53; 95% CI 4.04–7.58). Higher socioeconomic status was associated with a lower risk of keratoplasty.
Conclusions
This nationwide cohort study demonstrated a decreasing trend in keratoplasty for keratoconus in Taiwan from 2008 to 2020. However, acute hydrops remained the strongest predictor of undergoing keratoplasty.