Topical Insulin Eye Drops For Treating Persistent Corneal Epithelial Lesion Developed In A Rejected Penetrating Keratoplasty

To describe a case of persistent and recurrent epithelial lesions developed in a rejected corneal transplant, and its treatment with insulin eye drops (1 IU/ml).

Anterior segment service of the Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain.

We present a 53-year-old patient with history of keratoconus and rejected penetrating keratoplasty in right eye. The patient was admitted to the hospital complaining of redness, pain and decreased vision in right eye. The ophthalmic examination revealed non-infected corneal epithelial defect in the rejected graft. Sodium hyaluronic gel, corticosteroid, cycloplegic and antibiotics drops were prescribed. After two weeks of treatment epithelialization was not achieved. He underwent amniotic membrane transplant surgery twice and autologous serum drops were prescribed, without complete improvement of epithelialization. Treatment with topical insulin eye drops (1 IU/ml) every six hour was initiated. Since then, epithelial defect began to heal successfully. This treatment was maintained for four months associated with high density hyaluronic gel. Five weeks after discontinuing treatment with insulin eye drops, the ulcer recurred. Treatment with Insulin eye drops (1 IU/ml) was re-initiated with a favorable resolution of the epithelial defect.

Persistent epithelial defects are frequent complications in penetrating corneal transplant and are associated with decreased graft survival. Topical insulin eye drops (1 IU/ml) sould be considered as a successful alternative to treat persistent or recurrent epithelial defect developed in a corneal graft. Randomized prospective studies are needed to establish the appropriate management of persistent epithelial defects with topical insulin eye drops.