Topical Insulin for Persistent Corneal Epithelial Defects in Neurotrophic Keratopathy

Abstract

Purpose : To analyze the clinical outcomes of patients with neurotophic keratitis treated with topical insulin

Methods : Retrospective chart rewiew of patientes with neurotrophic keratitis resistant to conventional treatment. Patients were clasified into two groups. Group I: received insulin therapy with topical insulin at a concentration of 4 units per mL; while Group II: conventional treatment. Data was recorded from electronic medical records. Pre and post-treatment visual acuity anterior segment photographs, and epithelial defect dimensions were measured at each appointment. Quantitative variables were compared in both groups by paired and independent samples t-tests; and Chi-square and Fisher's exact test for qualitative variables.

Results : Results: 52 patients (52 eyes) fulfilled the inclusion criteria. 27 eyes were included in Group I and 25 eyes in Group II. Mean age for group I was 61.70 ± 3.28 years (range 55 – 68). For Group II, the mean age was 62.04 ± 3.61 years (range 55 - 69). Mean time between diagnosis and start of treatment was longer in group I than in Group II (87.33 ± 142.57 vs. 35.20 ± 100.84 days) (p = < 0.001). No differences were found in baseline characteristics between groups (p > 0.05). Re-epithelialization was achieved in 20 eyes (74%) in group I and 16 eyes (64%) in group II (p > 0.05). Mean time to re-epithelialization was 32.25 ± 4.40 days for the insulin group and 82.48 ± 6.84 days for the control (p = 0.000). Final defect area was smaller in the insulin group (3.79 ± 1.76 vs. 11.89 ± 2.37, p = < 0.001). Initial VA before therapy was 1.77 ± 0.98 logMAR for Group II and 1.84 ± 1.02 logMAR for Group I. Mean VA improved to 1.56 ± 0.98 logMAR for Group II and 1.89 ± 1.07 logMAR for Group I. No significant differences (p > 0.05) in terms of VA. There were no differences in recurrences, complications and subsequent surgical interventions between groups (p > 0.05).

Conclusions : Conclusion: Our findings suggest that the use of topical insulin was effective in accelerating epithelial defect closure in patients with refractory neurotrophic keratopathy, when compared to conventional treatment and may be highly advantageous due to its affordability and accessibility, however, it is not free of complications and recurrences.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.