Use Of Insulin Eye Drops In Persistent Epithelial Defects Refractory To Treatment

To analyse the results of the use of insulin eye drops in patients with persistent epithelial defect (PED) refractory to usual treatment in clinical practice in a Second- level hospital in Spain.

Hospital Infanta Cristina Department of Ophthalmology. Madrid, Spain.

A retrospective and descriptive study was performed. The medical records of 15 patients with PED during the year 2022 were reviewed. Data such as PED etiology, visual acuity (VA), recurrence rate, PED closure rate and the patient's subjective perception of improvement were analyzed. Treatment with topical insulin (1UI/ml)
every 6 hours was prescribed with ocular lubricants as adjuvants.

15 patients with PED were analyzed. PED etiology included: 4 herpetic keratitis (27%), 4 exposure keratopathies (27%), 3 corneal abscesses (20%), 2 corneal decompensations (13%), 1 eye drops toxicity (6.5%) and 1 corneal dystrophy (6.5%).  
11 patients (93%) healed without recurrence (27% of them had a complete recovery within the first 6 months of treatment) and 4 patients (27%) had to undergo surgery during follow-up due to lack of improvement and persistent recurrence.
The VA improved in 11 eyes (73%) (improvement greater than 3 lines in 4 eyes) and remained the same in 4 eyes (27%).   
The results obtained according to the patient's subjective assessment were: very good (13 cases, 87%), good ( 1 case, 6.5%) and mild (1 case, 6.5%).

Topical insulin is an effective alternative in the treatment of persistent epithelial defects in medium-sized hospitals with failure of other therapies or limited access to other treatments such as autologous serum and corneal transplants.
Its use is safe, effective and well tolerated, with the advantage of being an easily available treatment, accessible due to its low cost and not being dependent on blood products like autologous serum and plasma rich in growth factors