Comparison Of Topical Insulin And Autologous Serum For Epithelial Healing And Ocular Pain Scores After Corneal Cross-Linking

To compare the effects of topical insulin and autologous serum on epithelial healing and ocular pain scores following corneal cross-linking (CXL).

Patients with progressive keratoconus undergoing accelerated CXL were prospectively assigned to receive either topical insulin (1 IU/mL, 5 times/day) or autologous serum (%20, 5 times/day) postoperatively. Corneal epithelial defect size (CED) was determined with ImageJ software and calculated as a proportion of the total corneal area (TCA) from slit-lamp photography at postoperative days 1, 2, and 3. Ocular pain was assessed using a Visual Analogue Scale (VAS) with a scale of 0 to 10 at each visit.

The study included 17 patients in the autologous serum group and 16 patients in the topical insulin group. The mean age of the patients was 21.9±3.1 years, with no significant difference between the groups. At postoperative day 3, complete epithelial healing was observed in all patients in the topical insulin group, while it was achieved in 94% of patients in the autologous serum group. The CED/TCA ratio was similar between the groups on postoperative days 1 and 2 (autologous serum: 0.30±0.08 mm², 0.08 ±0.11 mm²; topical insulin: 0.35±0.08 mm², 0.05±0.04 mm²; p=0.809,p=0.852). Pain scores were lower in the topical insulin group compared to the autologous serum group at postoperative days 1 and 2 (p=0.007, p=0.003, respectively).

While topical insulin and autologous serum had comparable effects on epithelial healing after CXL, topical insulin was associated with significantly lower postoperative ocular pain scores