Abstract
This nationwide population-based study investigated the incidence rate of and risk factors for the progression to corneal transplantation in patients with keratoconus in South Korea using claims data from the Health Insurance Review and Assessment service. Among the entire South Korean population, 10,612 patients newly diagnosed with keratoconus between January 2010 and June 2015 were identified and included in the study. During the study period, 124 patients (1.17%) underwent corneal transplantation, with an average follow-up period of 2.97 ± 1.59 years. The incidence rate of corneal transplantation in patients with keratoconus was 4.46 cases per 1000 person-years. The rate of corneal transplantation for keratoconus was relatively low in South Korea compared to other countries. Multivariate Cox regression analysis revealed that male sex (HR 2.37; 95% CI 1.61-3.50; P < 0.001), severe atopic dermatitis (HR 2.32; 95% CI 1.02-5.28; P = 0.044), obstructive sleep apnea (HR 9.78; 95% CI 1.36-70.10; P = 0.023), and intellectual disability (HR 4.48; 95% CI 1.33-15.11; P = 0.016) significantly increased the risk of progression to corneal transplantation. In patients with keratoconus, male sex, severe atopic dermatitis, obstructive sleep apnea, and intellectual disability were associated with an increased risk of corneal transplantation.