Sociodemographic predictors of acute corneal hydrops in patients with unstable keratoconus.

Objective: To determine whether sociodemographic factors affect the outcomes of patients with unstable keratoconus. Design: Retrospective case control study. Subjects: All patients diagnosed with unstable keratoconus at Mass Eye and Ear between January 2016 and October 2022. Those who experienced acute corneal hydrops during the study period were considered cases, and those who did not were considered controls. Methods: Potential subjects were identified by billing code and verified with review of clinical documentation. Charts were reviewed for pertinent sociodemographic, medical, and ocular risk factors. Main Outcome Measures: Clinical diagnosis of acute corneal hydrops was the primary outcome. Receipt of corneal crosslinking (CXL) was a secondary outcome. Results: Of 762 patients diagnosed with unstable keratoconus, we identified 128 episodes of hydrops in 113 patients (14.9%). Compared to controls, cases were a significantly higher proportion Black (27.6% vs 14.6%, Conclusions: This study establishes several sociodemographic (Black race, unemployment, and publicly insured) and medical (high BMI and developmental delay) factors as independent risk factors influencing the incidence of hydrops and/or the receipt of CXL in a large group of patients with unstable keratoconus. Special attention is warranted when caring for patients within these subpopulations with unstable keratoconus, and further study into the mechanisms of these associations is warranted.