Ophthalmology and therapy · 2026
Topical Insulin for Corneal Persistent Epithelial Defects: A Multicenter Retrospective Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Lixi Filippo, Mancini Alessandra, Rossi Costanza, Corda Claudia, Pintus Benedetta, Lucisano Andrea, Bianca Federica, Mancini Maura, Verdiglione Mario, Coco Giulia, Tomi Mara, Gheorghe Alina Gabriela, Carnevali Adriano, Scorcia Vincenzo, Giannaccare Giuseppe
Аннотация
INTRODUCTION: The purpose of this study was to evaluate the clinical outcomes of insulin eye drops in a real-world cohort of eyes affected by corneal persistent epithelial defects (PEDs) refractory to conventional therapy.
METHODS: This retrospective study included consecutive patients with refractory PEDs treated with topical insulin (1 IU/mL) four times daily. Clinical end points were: time to complete reepithelialization, cumulative probability of closure, longitudinal changes in defect area, postclosure complications, recurrence, and changes in best-corrected visual acuity (BCVA).
RESULTS: A total of 45 eyes from 43 patients (mean age 64.6 ± 15.6 years) were included. The most common etiology was chronic ocular surface diseases (62.2%) followed by neurotrophic keratopathy (37.8%). Complete epithelial closure was achieved in 44 of 45 eyes (97.8%), with a median time to closure of 29 days (95%CI 24-38). The cumulative probability of complete reepithelialization was 20.0% at 14 days, 53.3% at 30 days, 90.5% at 60 days, and 95.3% at 90 days. A biphasic healing pattern was observed, with marked early reduction of the defect area progressively slowing over time (p < 0.001). Median BCVA improved from 2.0 to 1.0 logMAR at epithelial closure (p < 0.001). Two eyes (4.4%) experienced PED recurrence: one case regressed after first-line treatment while the other case progressed to corneal melting and ultimately required Gundersen flap surgery. No treatment-related adverse events were recorded.
CONCLUSIONS: Topical insulin may represent a safe, effective, and accessible therapeutic option for refractory PEDs, achieving high rates of complete reepithelialization with concomitant visual improvement and low short-term recurrence in a heterogeneous real-world cohort.
METHODS: This retrospective study included consecutive patients with refractory PEDs treated with topical insulin (1 IU/mL) four times daily. Clinical end points were: time to complete reepithelialization, cumulative probability of closure, longitudinal changes in defect area, postclosure complications, recurrence, and changes in best-corrected visual acuity (BCVA).
RESULTS: A total of 45 eyes from 43 patients (mean age 64.6 ± 15.6 years) were included. The most common etiology was chronic ocular surface diseases (62.2%) followed by neurotrophic keratopathy (37.8%). Complete epithelial closure was achieved in 44 of 45 eyes (97.8%), with a median time to closure of 29 days (95%CI 24-38). The cumulative probability of complete reepithelialization was 20.0% at 14 days, 53.3% at 30 days, 90.5% at 60 days, and 95.3% at 90 days. A biphasic healing pattern was observed, with marked early reduction of the defect area progressively slowing over time (p < 0.001). Median BCVA improved from 2.0 to 1.0 logMAR at epithelial closure (p < 0.001). Two eyes (4.4%) experienced PED recurrence: one case regressed after first-line treatment while the other case progressed to corneal melting and ultimately required Gundersen flap surgery. No treatment-related adverse events were recorded.
CONCLUSIONS: Topical insulin may represent a safe, effective, and accessible therapeutic option for refractory PEDs, achieving high rates of complete reepithelialization with concomitant visual improvement and low short-term recurrence in a heterogeneous real-world cohort.