HEALING OF CHEMICAL INJURY RELATED PERSISTENT CORNEAL EPITHELIAL DEFECTS WITH TOPICAL INSULIN

The purpose of this study was to evaluate the effectiveness of insulin eye drops for treating refractory persistent epithelial defects (PEDs). A persistent epithelial defect is defined as damage to the corneal epithelium which fails to heal within 2 weeks.

Moorfields Eye Hospital, London, United Kingdom

A prospective, interventional, single-centre, case series was performed from March 2020 to September 2021. All patients were prescribed insulin eye drops on compassionate grounds for the treatment of refractory PEDs, who failed on maximum standard medical (including serum eye drops) and surgical treatment. Patients were prescribed the drops to take four times a day for two months. Patients were followed up at 2 weekly intervals with full slit lamp examination and serial anterior segment photography. The primary end points were the rate and time to resolution of the epithelial defect

11 eyes of 10 patients were treated with insulin eye drops. Mean age of the cohort was 45.4 +25 years with a mean follow-up of 195.7 +114.3 days after re-epithelisation. The most common causative condition was chemical injury (n=5, 60%). Mean PED defect area at initiation of insulin was 41.3 +55.2 mm². 9 out of 11 eyes (82%) fully re-epithelised within a mean time of 62.3 +34.6 days (range 14-112). In the two patients who did not achieve re-epithelisation, one had a reduction in size from 12.25mm2 to 4.5mm2 and the other had no response. No recurrence in epithelial defect was observed in the group that had fully re-epithelised.

This study showed that the use of topical insulin eye drops led to a successful resolution of PED in 9 of the 11 cases. This is the first reported study to demonstrate the use of insulin drops for closure of PEDs in chemical eye injury. Insulin eye drops may be a safe and cost-effective treatment that adds to the current armamentarium in PED management.