Comparison of the efficacy of topical insulin with autologous serum eye drops in persistent epithelial defects of the cornea

Abstract

Purpose To investigate the effect of topical insulin on epithelization in persistent epithelial defects (PED) refractory to usual treatment compared to autologous serum. Design Retrospective, consecutive case–control series. Methods The charts of 61 consecutive patients with PED treated with topical insulin (case group) and 23 treated with autologous serum (control group) were reviewed. Primary efficacy end points were the percentage of patients in which epithelization was achieved, as well as the rate and time until epithelization. Secondary efficacy point was need for amniotic membrane transplantation (AMT) or other surgeries. Results Mean time between PED diagnosis and start of topical insulin was 22.7 ± 18.5 days (range 13–115) and the mean area was 14.8 ± 16.2 mm2 (range 1.1–70.6). In the control group, mean time was 27.9 ± 16.8 days, mean epithelial defect area being 18.6 ± 15.0 mm2 (range 1.7–52.9). No differences in baseline characteristics were found between groups (p > 0.05). Epithelization was achieved in 51 patients (84%) on insulin and 11 patients (48%) on autologous serum (p = 0.002). In those patients, mean time until reepithelization was 32.6 ± 28.3 days (range 4–124) in the insulin group and 82.6 ± 82.4 days (range 13–231) in the autologous serum group (p = 0.011). The need for AMT was significantly lower in the insulin group (p = 0.005). PED recurrence was higher in patients treated on autologous serum (43%) compared with insulin (11%) (p = 0.002). Conclusions Topical insulin is an effective treatment and safely promotes healing of PED. In our series, topical insulin presented better epithelization outcomes than autologous serum and could thus be considered as a first‐line treatment.

Pillar tarsoconjunctival flap: An alternative approach for the management of refractory corneal ulcer

“…Moreover, NGF drops has been suggested by them 1 and others authors. 17 Along the same lines, Diaz-Valle et al 18 proposed topical insulin as an effective and safe treatment for the management of PED. This treatment presented also better epithelization outcomes than AS, so they suggest that it could be first-line treatment.…”

Liposome–trimethyl chitosan nanoparticles codeliver insulin and siVEGF to treat corneal alkali burns by inhibiting ferroptosis

“…Cruz‐Cazarim et al 13 showed that INS could treat dry eye syndrome and corneal injuries. Morever, a recent clinical study suggested that topical INS was an effective way to safely promote the healing of persistent epithelial defects in patients who were unresponsive to standard treatment 14 . However, the use of INS in the treatment of corneal alkali burns has been rarely reported.…”

“…Morever, a recent clinical study suggested that topical INS was an effective way to safely promote the healing of persistent epithelial defects in patients who were unresponsive to standard treatment. 14 However, the use of INS in the treatment of corneal alkali burns has been rarely reported. We hypothesize that the local application of INS may be a promising strategy for the treatment of corneal alkali burns due to its antioxidant capacity.…”

Efficacy of Autologous Serum Gel in Neurotrophic Persistent Corneal Epithelial Defects Combined with Lagophthalmos

“…They are known to usually be resistant to healing with standard therapy such as frequent preservative-free artificial tears, ointments or gels, press patching, punctal plugging, and therapeutic contact lens wear. Several favorable results have been reported in PEDs associated with the use of autologous serum eye drops, insulin eye drops, amniotic membrane extract eye drops, epidermal growth factor (EGF) ointment, and recently developed topical recombinant human nerve growth factor (Cenegermin) [1][2][3][4][5][6][7]. However, PEDs that do not respond to even these drops need more aggressive methods to restore ocular surface health.…”

“…Autologous serum eye drops were introduced decades ago and known to contain several substances that aid in the regeneration of the keratoconjunctival epithelium, and many reports show their positive effects on neurotrophic PEDs [1][2][3][4]. Ointments or gels-though accompanied by concomitant visual blurring-are preferred modalities as conservative treatments for exposure keratopathy in lagophthalmos because of the increased contact time with the cornea [12].…”