Abstract
Purpose :
Keratoconus is a progressively ectatic corneal disease that leads to bilateral corneal stromal thinning and conical corneal bulging. Previous multi-center clinical trials have demonstrated the effectiveness of corneal crosslinking (CXL) in treating progressive keratoconus. However, previous cohort studies and case series have reported a wide range of CXL failure rates that range from 0-23%. This study aims to characterize rates of corneal crosslinking (CXL) failure in patients with keratoconus using a large insurance claims database.
Methods :
A retrospective claims-based analysis was conducted of patients in IBM® MarketScan®, a nationally representative sample of commercial insurance beneficiaries, who underwent corneal crosslinking (CXL) from 2007-2022. We excluded patients who had enrollment beginning less than one year before initial CXL and patients who had undergone previous penetrating keratoplasty [PK] or deep anterior lamellar keratoplasty [DALK]. The primary study outcome was time to treatment failure repeat CXL, penetrating keratoplasty [PK], or deep anterior lamellar keratoplasty [DALK]) identified by Current Procedural Terminology (CPT-4) codes.
Results :
Between 2007 and 2022, 3107 eyes from 2356 patients with keratoconus underwent CXL. The mean age was 31.8 ± 11.3 years. 1590 of 2356 (67.5%) were male. The mean enrollment length was 4.6 ± 3.8 years. 37 (1.2%) of eyes from 35 patients experience treatment failure. Of these 31 of 37 (83.7%) underwent a repeat CXL, with the remainder undergoing PK or DALK. The mean time to a repeat CXL, DALK, or PK was 182 ± 258 days. CXL failure was more likely to occur in patients with allergic or atopic disease (56.8% vs 40.0%, p =0.03). There was no difference in failure rates by pediatric status (18.9% vs 12.9%, p = 0.28), sleep apnea (21.6% vs 14.8%, p < 0.25), or gender (40.5% vs 33.2% female, p = 0.34).
Conclusions :
Approximately 1 in 80 eyes with keratoconus that underwent CXL required a repeat CXL, PK, or DALK. Allergy and atopic disease were associated with a higher treatment failure rate.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.