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B.H. Jeng, D.S. Holsclaw, A.B. Kumar, J.P. Whitcher, I.G. Wong, T.P. Margolis, D.C. Gritz; Epidemiology of Corneal Ulcers in Northern California . Invest. Ophthalmol. Vis. Sci. 2003;44(13):805.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate the epidemiology of corneal ulcers, including the incidence rate, through a hospital-based cross-sectional study in Northern California. Methods: Retrospective chart review was performed for all patients diagnosed with a corneal ulcer between September 1, 1998 and August 31, 1999 in 9 target community medical centers. Patient records documenting a corneal epithelial defect with underlying stromal inflammation were included. Viral and immune-mediated ulcers were excluded. A dynamic population model was used to calculate both overall and age- and sex-stratified incidence rates. Results: Of 468 charts reviewed, 302 patients fulfilled the inclusion criteria. The mid-period study population served by the medical centers was 1,094,934 yielding an incidence of 27.6 per 100,000 person-years, which allows for an estimation of 75,200 corneal ulcers annually in the United States. The highest rate of corneal ulceration was found in females 25-34 years old with an incidence of 60.3 per 100,000 person-years. The lowest rate of corneal ulceration was found in males less than 15 years old with an incidence of 0.9 per 100,000 person-years. Risk factors for corneal ulceration included contact lens use (55.0%), ocular surface disease (16.6%), trauma (11.9%), and bullous keratopathy (1.3%). The relative risk for corneal ulceration in contact lens wearers compared to non-wearers was 8.6. Seven of 2,944 known HIV-infected people developed corneal ulcers, yielding an incidence of corneal ulceration in HIV-infected patients of 237.8 per 100,000 person-years. The relative risk for corneal ulceration in HIV-infected individuals compared to non-HIV-infected individuals was 8.8. Conclusions: Based on our study, the incidence of corneal ulceration in the United States is higher than previously reported, with the majority of cases being associated with contact lens wear. This incidence is lower, however, than that reported in underdeveloped countries where trauma accounts for the majority of cases of corneal ulceration. HIV-infected individuals have a much higher incidence of corneal ulceration.
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