ESCRS - FP27.15 - Impact Of Topical Insulin As A Therapeutic Intervention For Corneal Diseases: A Comprehensive Systematic Review And Meta-Analysis

Impact Of Topical Insulin As A Therapeutic Intervention For Corneal Diseases: A Comprehensive Systematic Review And Meta-Analysis

Published 2025 - 43rd Congress of the ESCRS

Reference: FP27.15 | Type: Free paper | DOI: 10.82333/52j8-7n03

Authors: Avinoam Shye* 1 , Aya Wattad 1 , Igor Kaiserman 2 , Gur Munzer 3 , Tzachi Sela 3 , Michael Mimouni 4 , Eyal Cohen 5

1Ophthalmology,Tel Aviv Sourasky Medical Center,Tel Aviv,Israel, 2Ophthalmology,Barzilai Medical Center,Ashkelon,Israel;Care-Vision Laser Center,Tel Aviv,Israel;Faculty of Health Sciences,Ben-Gurion University of the Negev,Beer Sheba,Israel, 3Care-Vision Laser Center,Tel Aviv,Israel, 4Ophthalmology,Rambam Health Care Campus,Haifa,Israel;Ruth and Bruce Rappaport Faculty of Medicine,Technion - Israel Institute of Technology,Haifa,Israel, 5Ophthalmology,Tel Aviv Sourasky Medical Center,Tel Aviv,Israel;Care-Vision Laser Center,Tel Aviv,Israel;Faculty of Medicine,Tel Aviv University,Tel Aviv,Israel

Purpose

Persistent epithelial defects (PEDs) are challenging corneal conditions with prolonged non-healing. Commonly associated with dry eye disease and neurotrophic keratopathy (NK), PEDs can lead to severe complications. Topical insulin has emerged as a therapeutic option, promoting epithelial healing. This systematic review and meta-analysis aim to evaluate the effectiveness of topical insulin in treating corneal conditions.

Setting

Systematic review and meta-analysis.

Methods

This study was pre-registered in PROSPERO (CRD42024557375). A systematic search was conducted in Medline, Embase, Web of Science and Cochrane Library databases following PRISMA guidelines for studies reporting topical insulin for PEDs of any etiology and corneal epithelial defect (CEDs) post-vitrectomy. Healing time, complete wound healing (CWH), epithelization failure (EF), and epithelial healing rate were the study analysis outcomes. All records were assessed by two authors and performed quality evaluations. Statistical analyses employed random-effects models and I² statistics.

Results

Fourteen studies involving 284 eyes were included. Mean healing time for all conditions was 20.68 days (95% CI: 11.60, 29.76) with significant heterogeneity. The pooled CWH rate was 94% (95% CI: 87-98%), with an odds ratio of 5.41 and low heterogeneity (I² = 0%) favoring topical insulin over controls. EF was low at 5% (95% CI: 0-13%), and the epithelial healing rate was 0.82 mm²/hour (95% CI: 0.02, 1.62), favoring the intervention group over controls. Sensitivity sub-analysis identified studies driving heterogeneity, with I² reductions, notably from 94% to 0% in NK and 96% to 0% in CED, highlighting their impact on variability. Other analyses confirmed the influence of certain studies on overall heterogeneity and effect estimates.

Conclusions

Topical insulin is effective in corneal wound healing, demonstrating high CWH rates and low failure rates. Despite limitations such as heterogeneity and variability in study designs, topical insulin presents a promising therapeutic option. Further, well-controlled studies are needed to validate these findings and assess long-term outcomes.