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Angeline L Wang, Eric Weinlander, Brandon Metcalf, David M Gamm, Michael Struck; The use of topical insulin to treat refractory neurotrophic corneal ulcers. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1249.
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© ARVO (1962-2015); The Authors (2016-present)
Refractory neurotrophic corneal ulcers are clinically challenging and potentially blinding. Current research focuses on targeted therapies to improve corneal epithelial healing in these cases. Insulin has been shown to improve corneal epithelial healing in vitro and in diabetic animal models; however, clinical experience with topical insulin in patients with non-healing corneal wounds is limited. The purpose of this study is to present three cases of refractory neurotrophic corneal ulcers that were treated with topical insulin.
Retrospective chart review of patients' exam findings, medications, and procedures. Regular insulin at a concentration of 1 unit per mL of artificial tears was prescribed topically as one drop two or three times daily.
The three patients included a 2-year-old girl with a history of excised orbital teratoma and proptosis; a 2-year-old boy with aniridia, congenital glaucoma status post multiple glaucoma procedures, and bilateral corneal decompensation; and a 24-year-old woman with a history of herpes zoster keratoconjunctivitis. All three patients were noted to have decreased or absent corneal sensation in one eye. Each patient developed a neurotrophic corneal ulcer with associated epithelial defect and stromal thinning. The ulcers were refractory to a range of traditional treatments, up to and including surgical management with permanent tarsorrhaphy in one patient. The addition of topical insulin resulted in complete corneal re-epithelialization ranging from 13 to 25 days following initiation of treatment. One patient reported increased eye irritation and redness with the treatment; no systemic side effects were noted.
Topical insulin may be an effective treatment for refractory neurotrophic corneal ulcers. Proposed mechanisms include increased corneal epithelial cell migration and restoration of bidirectional trophic signaling through preservation of corneal nerves. Insulin has been shown to promote cell migration and closure of artificial wounds in cultured sheets of corneal epithelial cells. In diabetic mice, topical insulin appears to slow the loss of sub-basal plexus corneal nerves. Further study is needed to determine the clinical efficacy and side effect profile of topical insulin in corneal wound healing.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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