Higher incidence of penetrating keratoplasty having effects on repeated keratoplasty in South Korea: A nationwide population-based study.

Kyoung Yoon Shin,Tae-Young Chung,Dong Hui Lim,Kyungdo Han,Manuel Garza León

doi:10.1371/journal.pone.0235233

Abstract

PurposeTo investigate the incidence of corneal transplantation and identify rates and risk factors of repeated corneal transplantation in South Korea.MethodsThis is a retrospective population-based cohort study using the Korean National Health Insurance System database. Among the entire South Korean population (N = 51,827,813), we included those who underwent corneal transplantation more than once between January 2006 and December 2016, and analyzed the annual incidence of keratoplasty. The person-year incidence of repeated keratoplasty after the first operation was calculated according to risk factors including age group, sex, income level, surgical method, surgical etiology, and presence of major systemic diseases. Cox regression analysis was employed to evaluate the hazard ratios of those risk factors on repeated keratoplasty.ResultsA total of 9,452 cases of corneal transplantation occurred from January 2006 to December 2016. The average annual incidence of corneal transplantations was 1.694 per 100,000. The proportion of penetrating keratoplasty steadily decreased from 92.22% in 2006 to 77.81% in 2016. The average incidence of repeated keratoplasty among those who underwent corneal transplantation at least once was 43.24 per 1,000 person-years. Males had a greater incidence of repeated keratoplasty compared to females (males: 47.66 per 1,000, females: 36.04 per 1,000). The age group from 20 to 39 years demonstrated the lowest incidence of repeated keratoplasty at 24.94 per 1,000. Keratoconus had the lowest incidence of repeated keratoplasty (22.82 per 1,000).ConclusionThis study may provide a better understanding of corneal diseases, help predict disease burden, and plan health care systems accordingly in South Korea.

Highlights

The spectrum of causative corneal diseases differs by country and ethnicity, and the prevalence of corneal blindness is diverse in each geographical area [1]
This study may provide a better understanding of corneal diseases, help predict disease burden, and plan health care systems in South Korea
The rate of corneal transplantation is significantly higher in the United States compared to other countries, and Western countries have a higher proportion of endothelial keratoplasty, since Fuch’s dystrophy is much more prevalent compared to Eastern countries [2]

Summary

Introduction

The spectrum of causative corneal diseases differs by country and ethnicity, and the prevalence of corneal blindness is diverse in each geographical area [1]. Fuch’s dystrophy is often encountered in the Unites States and Western countries, while keratoconus is much more prevalent in the Middle East, and infectious keratitis is the most common reason for keratoplasty in developing countries in Southeast Asia [2,3,4]. The overall rate of corneal transplantation and the proportion of implemented surgical techniques (penetrating keratoplasty, anterior lamellar keratoplasty, and endothelial keratoplasty) vary from country to country since they are affected by factors such as prevalence and causes of corneal blindness, as well as by socioeconomic parameters such as accessibility to health care and corneal procurement rate [5]. The rate of corneal transplantation is significantly higher in the United States compared to other countries, and Western countries have a higher proportion of endothelial keratoplasty, since Fuch’s dystrophy is much more prevalent compared to Eastern countries [2]. The rate and incidence of repeated corneal transplantation vary by country and ethnicity

Methods

Results

Conclusion