Purpose To report the clinical course of 6 patients with refractory neurotrophic corneal ulcers that were treated with topical insulin drops. Methods Retrospective chart review of patients who had neurotrophic corneal ulcers or epithelial defects refractory to standard medical and surgical treatment. Insulin drops, prepared by mixing regular insulin in artificial tears with a polyethylene glycol and propylene glycol base at a concentration of 1 unit per mL, were prescribed 2–3 times daily. Results Six patients, 2 to 73 years of age, developed neurotrophic corneal ulcers refractory to a range of medical and surgical treatments, including bandage contact lens, amniotic membrane grafting and permanent tarsorrhaphy. Each patient was started on topical insulin drops with complete corneal re-epithelialization within 7 to 25 days. Conclusion Topical insulin may be a simple and effective treatment for refractory neurotrophic corneal ulcers. Further study is needed to determine the clinical efficacy and side effect profile of insulin drops.
t is largely accepted that intraoc ular lens (IOL) implantation for unilateral or bilateral cataract is the standard of care for children older than 24 months. 1-7 Multiple studies have shown that it may be technically feasible to implant an IOL shortly after birth, but outcomes have not dramatically improved and the rate of adverse events has increased. 8-11 Recently, the prospective Infantile Aphakia Treatment Study (IATS) has reported no significant benefit in this approach, with the conclusion by Plager et al 12 that surgeons should exercise caution when considering IOL implantation in children younger than 7 months. The understanding of treatment of c atarac t in children between approximately 6 and 24 months of life is unclear. The goal of this study is to report the longt e r m o u t c o m e s o f c h i l d r e n u n d e r g o i n g p r i m a r y posterior chamber IOL implantation who did not require cataract surgery until after age 6 months but before age 24 months. Methods Records from November 2001 to June 2012 were retrospectively reviewed for all children who underwent primary IOL implantation between ages 6 and 24 months. Congenital cataracts were included only if they were partial at birth and did not initially require surgical intervention. Final optotype acuity, adverse events, refractive growth, strabismus, binocular function, and need for additional surgery were recorded for 14 eyes of 10 patients. This study was approved by the University of Wisconsin Institutional Review Board and compliant with the Health Insurance Portability and Accountability Act of 1996. Informed consent was not required owing to the retrospective nature of the study. Surgery Patients underwent A-scan ultrasonography in the operating room (eTable in the Supplement). The algorithm for postop-IMPORTANCE Pediatric primary posterior intraocular lens (IOL) implantation in children older than 24 months has become the standard of care. Results of the Infantile Aphakia Treatment Study have concluded that primary IOL implantation before age 7 months has no advantages over aphakia. The current evidence does not address our understanding of the risks and benefits of primary IOL implantation for children aged 7 to 24 months. OBSERVATIONS Final optotype acuity, adverse events, refractive growth, strabismus, binocular function, and need for additional surgery were retrospectively reviewed for 14 eyes of 10 patients from November 2001 to June 2012. The records were reviewed for children aged 6 to 24 months; included patients were aged 7 to 22 months. The mean (SD) visual acuity was 0.29 (0.30) logMAR (Snellen equivalent 20/40). The mean follow-up was 5 years. The rate of adverse events was 3 in 14 eyes (21%). Adverse events included lens reproliferation (2 eyes) and lens dislocation (1 eye). The rate of strabismus correction was 4 in 10 patients (40%). The mean (SD) rate of refractive growth at 3 times the age at surgery was −5.80 (3.09) diopters. CONCLUSIONS AND RELEVANCE The data suggest that primary IOL implantation in this age group...
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