Management of refractory persistent epithelial defect treatment with topical insulin: An Indian pilot study

To evaluate the safety and efficacy of topical insulin in managing refractory persistent epithelial defects (PEDs) and its potential to prevent complications and surgical intervention.

This prospective interventional study involved 22 patients aged >18 years with PEDs refractory to standard care. Patients with neurotrophic keratitis (8), chemical injury (3), neuroparalytic keratitis (1), and postcorneal transplant (10) were included. Topical insulin eye drops (1 IU/ml), prepared with regular insulin in a polyethylene glycol base, were administered four times a day. Patients were monitored over 6 months, with the size and extent of the epithelial defect assessed at each visit.

The mean area of the PED before treatment was 13.17 ± 9.7 mm². The average duration between the diagnosis of PED and the initiation of insulin eye drops was 13.2 ± 4 days. Complete healing was achieved in 17 of 22 eyes (77.2%) within 1 month and in 19 of 22 eyes (86%) within 6 weeks. The average reepithelization time was 21.5 ± 8.8 days. Best-corrected visual acuity improved significantly, from 1.1 ± 0.2 logMAR units to 0.8 ± 0.3 logMAR units (P < 0.001). No cases of PED recurrence were observed during the follow-up period.

Topical insulin eye drops promote healing of refractory PEDs, demonstrating good ocular and systemic tolerance. However, long-term and comparative studies are needed to confirm their safety and to support their potential inclusion as a first-line treatment for PED management.