TOPICAL INSULIN FOR PERSISTENT CORNEAL DEFECTS – AN OLD ACQUAINTANCE WITH A NEW ROLE?

To evaluate the effects of topical insulin in patients with persistent corneal epithelial defects that are refractory to the standard treatment.

A prospective non-randomized hospital-based study was performed. Patients with different types of persistent epithelial defects refractory to standard treatment were treated with topical insulin 1 U.I./mL 4 times a day. Patient demographics, etiology, and comorbidities were reviewed. The rate of epithelial healing was the considered primary outcome measure.

11 patients (12 eyes) were treated with insulin eye drops (7 females and 4 males; mean age of 65.2 years). Neurotrophic keratitis was the most common cause of persistent epithelial defect (75%), and within this, herpetic eye disease was the main comorbidity (44%). The mean follow-up time was 12.9 weeks. 8 of 12 eyes (66.7%) had complete resolution and 3 of 12 eyes (25%) had significant improvement although the wound didn’t fully heal. One patient abandoned the study 2 weeks after due to poor adherence. The mean time of reepithelization for the eyes with full recovery was 27.1 days (range 7-61 days). There were no reports of complications or side effects during the time of the study.

These results suggest that topical insulin could be a good therapeutic alternative for persistent corneal defects due to its good safety profile, availability, and affordability. Because there are few therapeutic alternatives, it may have a promising role as an adjuvant in the management of persistent epithelial defects, possibly avoiding invasive surgical treatments. Highlight that our results are consistent with the published articles. More studies need to be developed to better understand the value of this new field of action for Insulin.