Article

Topical insulin as a treatment for refractory persistent epithelial defects

January 2025
Acta Ophthalmologica 103(S284)

DOI:10.1111/aos.17187

Authors:

Elena Arias Garcia

University of Valencia

Cristina Peris-Martinez

FUNDACIÓN DE OFTALMOLOGIA MEDICA DE LA COMUNITAT VALENCIANA (FOM)

Aims/Purpose: To present a case series of patients with persistent epithelial defects (PED) of different etiologies treated with topical insulin after failure of conventional treatments and evaluate its efficacy. Methods: We reviewed the clinical history of 17 patients with PED that were treated with topical insulin since 2020, refractory to conventional treatments. Results: Of the 17 patients with PED that we reviewed, 16 of them achieved reepithelization with topical insulin after failure of conventional treatment. Reepithelization mean time was 29 days (range 6‐60 days). Recurrence of the epithelial defect was observed in 2 patients. None of the patients that achieved epithelization needed extra treatment after topical insulin in order to solve the PED. No adverse effects were reported with the use of topical insuline and it was well tolerated. Conclusions: Topical insulin is a very effective treatment for reepithelization of refractory persistent epithelial defects with good tolerance, no adverse effects, and good availability and cost‐effectiveness in comparison to other treatments. References Aynsley TR. THE USE OF INSULIN IN THE TREATMENT OF CORNEAL ULCERS. Br J Ophthalmol. 1945 Jul;29(7):361‐3. doi: 10.1136/bjo.29.7.361. PMID: 18170130; PMCID: PMC513802. Zagon IS et al. Use of topical insulin to normalize corneal epithelial healing in diabetes mellitus. Arch Ophthalmol. 2007 Aug;125(8):1082‐8. doi: 10.1001/archopht.125.8.1082. PMID: 17698755. Diaz‐Valle D et al. Topical insulin for refractory persistent corneal epithelial defects. Eur J Ophthalmol. 2021 Sep;31(5):2280‐2286. doi: 10.1177/1120672120958307. Epub 2020 Sep 21. PMID: 32951459. Diaz‐Valle Det al. Comparison of the efficacy of topical insulin with autologous serum eye drops in persistent epithelial defects of the cornea. Acta Ophthalmol. 2022 Jun;100(4):e912‐e919. doi: 10.1111/aos.14997. Epub 2021 Aug 18. PMID: 34407296. Wang AL et al. Use of Topical Insulin to Treat Refractory Neurotrophic Corneal Ulcers. Cornea. PMID: 28742619; PMCID: PMC5633504. NaPier E et al. Neurotrophic keratopathy/ current challenges and future prospects. Ann Med.. PMID/ 35243932; PMCID/ PMC8903790.