Topical Insulin for Neurotrophic Keratopathy and Persistent Corneal Defects

By Dr. Kevin -

 

A recent retrospective study published in Cornea highlights topical insulin as an
effective off-board intervention for difficult-to-heal corneal defects.

  • How It Works: Topical insulin binds to insulin and IGF-1 receptors on the cornea, triggering signaling pathways that accelerate epithelial cell migration to close wounds.

  • Key Findings: Researchers evaluated 57 eyes treated with 1 IU/mL of topical insulin four times daily.

    • Neurotrophic Keratopathy (NK): Achieved the highest success rate at 83.9%. Among eyes with persistent epithelial defects, 71.4% achieved complete closure in an average of five weeks.

    • Visual Acuity & Symptoms: 42.9% of NK patients gained at least one line on the Snellen chart, alongside notable improvements in pain, irritation, and photophobia.

  • Condition Variance: Results varied significantly across other surface diseases, showing a 44.4% success rate for dry eye disease (DED) and only 14.3% for graft-versus-host disease (GVHD).

  • Safety: The treatment was well-tolerated, with only one instance of temporary intraocular pressure increase linked to concurrent steroid use.

While these retrospective findings are encouraging for NK management, authors emphasize the need for prospective clinical trials to establish standardized treatment protocols.

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