Role of topical insulin in the management of resistant neurotrophic corneal ulcers.

PURPOSE: This study aims to evaluate the clinical outcomes of patients with refractory neurotrophic keratitis (NK) who were unresponsive to standard therapies and treated with topical insulin.

METHODS

In this prospective analysis, 16 eyes with stage 2 or 3 NK were treated with topical insulin. These patients had been refractory to standard medical treatment. Informed consent was obtained from patients before starting treatment. Each patient applied topical insulin drops (10 units/1mL) six times a day, along with prophylactic fluoroquinolone drops. Treatment was continued until the persistent NK resolved, and anterior segment photos were taken regularly.

RESULTS

The study included 16 eyes of 15 patients with a mean age of 59 years. Initial visual acuity was poor, averaging 1.7 log MAR. Topical insulin treatment led to significant improvements: 75% of patients showed improved visual acuity with a mean gain of 0.5 log MAR. The mean healing time for ulcers was 12.3 days, with a healing rate of 93.75%. No complications or side effects were reported.

CONCLUSIONS

Several studies have explored the use of topical insulin in treating neurotrophic corneal ulcers, employing various concentrations. Our study is the first to use a concentration of 10IU/mL. Our findings suggest that topical insulin therapy could be an effective treatment for refractory neurotrophic keratitis (NK) due to its high efficacy, accessibility, and low cost. While our study may have identified an optimal insulin concentration, further research with larger sample sizes is needed, including investigations into other causes of refractory corneal ulcers.