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Michelle White, James Chodosh, Claes H Dohlman; Incidence of Stevens-Johnson Syndrome and Chemical Burns to the Eye. Relevance for Keratoprosthesis Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5456.
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Stevens-Johnson Syndrome,Toxic Epidermal Necrolysis, Toxic Epidermal Necrolysis/Stevens-Johnson Syndrome (SJS spectrum) and alkali or acid burn of the cornea/conjunctiva (chemical burns) represent potentially devastating causes of severe corneal blindness. This study was designed to estimate the incidence and distribution of SJS spectrum and chemical burns using a large administrative claims database in the United States (US).
The 2010 Nationwide Emergency Department Sample (NEDS) database was queried for ICD-9 codes corresponding to SJS spectrum and chemical burns. The NEDS is the largest all-payer ED database in the US and contains between 25-30 million (unweighted) ED visits.
As a primary diagnosis in the emergency rooms of the US in 2010, there were about 2,800 SJS spectrum and about 3,800 chemical burns. Thus, the overall incidence rate (adjusted to 2010 US population) for SJS spectrum and chemical burns were 9.1 and 12.3 cases per million people per year respectively. From the literature, approximately 30% of ocular chemical injuries and 50% of SJS spectrum result in severe vision reduction, together affecting about 2,500 people in the US per year. The mean age of patients suffering from SJS spectrum and chemical burns was 45 and 38 years, respectively. Men were more likely to suffer from chemical burns (70%) and women were more likely to suffer from SJS spectrum (55%). Distribution was equal throughout metropolitan and rural environments, as well as different regions of the US except that SJS spectrum occurred more frequently in southern US (39% of occurrences in the south vs. 17-24% in other regions). If the US incidence rates are extrapolated to the world population in 2010, about 62,000 cases of SJS spectrum, with up to 31,000 suffering from severe vision reduction, would be expected to have occurred in 2010 worldwide. Similar extrapolations for chemical burns can not be made since the incidence is so much higher in the developing world.
SJS spectrum and chemical burns affect a relatively small subset of the population but occur in younger patients, leading to a relatively high impact over the course of their lifetimes. Keratoprosthesis has had success in restoring vision in patients with SJS spectrum and chemical burns and may significantly minimize the burden of these conditions.
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