Topical Autologous Platelet-Rich Plasma Versus Insulin Eye Drops In The Treatment Of Neurotrophic Keratopathy

To evaluate and compare the efficacy and safety of autologous platelet-rich plasma (PRP) eye drops and topical insulin eye drops in patients with neurotrophic keratopathy presenting with nonhealing corneal ulcers.

This prospective study included 90 patients with neurotrophic corneal ulcers treated at the Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Poland. Sixty patients received PRP eye drops and thirty were treated with topical insulin.

Ninety patients with neurotrophic keratopathy due to herpes simplex, herpes zoster infection, or facial/trigeminal nerve paralysis following neurosurgery were enrolled. Patients received autologous PRP eye drops five times daily (n=60) or insulin eye drops four times daily (n=30), in addition to preservative-free artificial tears and vitamin A ointment at night and antiviral treatment if necessary. Outcomes included best-corrected visual acuity (BCVA), corneal epithelial healing, subjective symptom improvement, corneal thickness measured by anterior segment optical coherence tomography (AS-OCT), and the need for additional surgical intervention.

Mean BCVA improved significantly from 0.14 ± 0.19 to 0.37 ± 0.31 in the PRP group and from 0.16 ± 0.18 to 0.44 ± 0.31 in the insulin group (p=0.001). Baseline ulcer size was comparable between groups. Subjective symptoms improved in all patients; fluorescein staining decreased in 82% and conjunctival hyperemia in 93%. Corneal thickness at the thinnest point increased significantly (p=0.01). Complete epithelial healing occurred in 85% of PRP-treated and 90% of insulin-treated patients. Mean treatment duration was approximately five weeks. No adverse effects were observed.

Both autologous platelet-rich plasma and topical insulin eye drops are safe and effective therapeutic options for neurotrophic keratopathy, promoting corneal epithelial healing, improving visual acuity, and increasing corneal thickness in most patients. These treatments may represent valuable non-surgical alternatives for managing persistent neurotrophic corneal ulcers.