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

Purpose: 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.

Methods: 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.

Result: 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.

Conclusion: 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.