Title : Accelerating corneal epithelial healing with topical insulin
Abstract:
Purpose: To evaluate the efficacy and safety of topical insulin in promoting corneal epithelial healing in cases of refractory persistent epithelial defects (PEDs) unresponsive to conventional therapies.
Design: Prospective interventional case series.
Methods: Twenty eyes with refractory PEDs of various etiologies (neurotrophic keratopathy, diabetic keratopathy, post-surgical epithelial defects, and exposure keratopathy) that failed to respond to standard medical therapy (lubrication, bandage contact lens, autologous serum, or tarsorrhaphy) were included. Patients received topical regular human insulin (1 IU/mL) instilled four times daily in addition to conventional therapy. Follow-up examinations were performed at days 3, 7, 14, and 30. The main outcome measure was time to complete epithelial closure, confirmed by fluorescein staining. Secondary outcomes included improvement in best-corrected visual acuity (BCVA), recurrence rate, and adverse effects.
Results: Complete epithelial healing was achieved in 18 of 20 eyes (90%) within an average of 11.2 ± 3.4 days. Partial healing occurred in 2 eyes, which showed significant reduction in defect size. Mean BCVA improved significantly from 0.42 ± 0.21 to 0.68 ± 0.17 (p < 0.01) after treatment. No local or systemic adverse reactions were observed. No recurrence was noted during the 3-month follow-up period.
Conclusion: Topical insulin demonstrated a significant and consistent improvement in corneal epithelial healing in refractory PEDs. It appears to be a safe, simple, and cost-effective adjunctive therapy that may serve as an accessible alternative in cases unresponsive to standard treatment.
