Incidence of Ulcerative Keratitis in the United States With and Without Predisposing Diabetes Mellitus

OBJECTIVES: To assess the incidence of ulcerative keratitis (UK) in the United States between 2017 and 2024 and determine the risk of ulcerative keratitis development in patients with and without diabetes mellitus (DM). METHODS: The TriNetX analysis platform was used to retrospectively analyze data from US health care organizations and run analyses to calculate incidence rates of UK. Subsequently, patients with and without DM were identified to determine risk of UK development after propensity score matching for baseline demographic characteristics. RESULTS: The incidence rate of ulcerative keratitis fluctuated between 2017 to 2024, increasing to 30.06 cases per 100,000 person-years in 2024. Patients with DM exhibited increased risk of UK compared with those with no DM within one year of follow-up (RR, 1.601; 95% CI, 1.239-2.069). Among patients diagnosed with DM, those who had recorded hemoglobin A1c values greater than 8% exhibited increased risk of UK development compared with patients with hemoglobin A1c levels below 8% (RR, 1.14; 95% CI, 1.058-1.228). CONCLUSIONS: UK incidence was found to increase to a high of 30.06 cases per 100,000 person-years in 2024. Increased risk of UK was also found with DM, particularly at hemoglobin A1c levels above 8%, underscoring how pathophysiological mechanisms underlying DM can negatively affect corneal health.