ESCRS - POCOR095 - Combined Use Of Insulin Eye Drops And Cross-Linked Hyaluronic Acid Canalicular Gel For The Management Of Severe Neurotrophic Keratopathy

Combined Use Of Insulin Eye Drops And Cross-Linked Hyaluronic Acid Canalicular Gel For The Management Of Severe Neurotrophic Keratopathy

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR095 | Type: Case Report | DOI: 10.82333/hxdb-jq02

Authors: Dr Filippo Lixi* 1 , Dr Camilla Bianchi 1 , Dr Claudia Corda 1 , Dr Mario Verdiglione 2 , Prof. Dr Giulia Coco 3 , Prof. Dr Giuseppe Giannaccare 1

1Department of Surgical Sciences,University of Cagliari,Cagliari,Italy, 2Compounding Pharmacy,Catanzaro,Italy, 3Department of Clinical Sciences and Translational Medicine,University of Rome Tor Vergata,Roma,Italy

Purpose

This case aimed at reporting the successful outcomes of a severe recalcitrant NK treated with 2-month course of insulin eye drops combined with the insertion of cross-linked HA canalicular gel.

Setting

Single-center, case report conducted at the Complex Ophthalmology Unit, University Hospital of Cagliari (Cagliari, Italy).

Report of case

A 52-year-old male presented with a recalcitrant Mackie stage III post-herpetic NK in the right eye, characterized by a large PED (area of 49.7 mm²), central stromal melting, corneal anaesthesia, and neovascularization. Best-corrected visual acuity (BCVA) was reduced to hand movements. Treatment planning included the withdrawal of previous therapies and the initiation of topical insulin (1 unit/mL, 4 times daily) combined with the insertion in the lower punctum of cross-linked hyaluronic acid canalicular gel (Lacrifill, Nordic Pharma, Inc., Berwyn, PA, US) to enhance ocular surface drug retention. In the following follow-up visits, PED area reduced progressively to 19.6 mm² at 2 weeks and 4.4 mm² at 4 weeks. Complete re-epithelialization was achieved at 8 weeks. In parallel, BCVA improved to 1.8 logMAR. No adverse events were reported.

Conclusion/Take home message

The combined use of topical insulin and cross-linked hyaluronic acid canalicular gel allowed to achieve complete corneal healing in a case of severe recalcitrant NK complicated by corneal melting. The regenerative properties of insulin eye drops were enhanced by the concomitant insertion of the occlusive device. This approach represents a rational, accessible, and well-tolerated therapeutic strategy that warrants further evaluation in prospective controlled studies.