Topical Insulin—A possible treatment in Refractory Neurotrophic Keratopathy—Quasi‐Experimental Study

Abstract

AbstractPurposeTo evaluate the clinical progression of patients with refractory Neurotrophic Keratopathy (NK) treated with topical insulin eye drops and its efficacy in treating NK in stages 2 and 3.MethodsQuasi‐Experimental, randomized study, from October 2018 to December 2019, of 10 patients (11 eyes—13 to 92 years) with NK in stages 2 and 3. Patients included were refractory to standard medical and/or surgical treatment. Drops were applied 3‐4 times a day and a bandage contact lens was applied. Close follow‐up of patients was assured (daily in week one and weekly thereafter) and anterior segment photos were taken on each visit. Insulin eye drops were continued until the NK persistent epithelial defect or ulcer resolved. Treatment would be discontinued if the condition did not improve or worsened.ResultsTen out of eleven eyes had complete resolution of the NK persistent epithelial defect and/or ulcer within 12‐45 days of follow‐up. One of the patients’ epithelial defect improved significantly although the wound did not fully heal within 42 days of treatment. No side‐effects were reported during the full extent of the treatment.ConclusionsAlthough we recognize some limitations to our study (uncontrolled series of patients), our results suggest that topical insulin drops could be an effective treatment in refractory NK. Furthermore, this therapy may prove extremely useful due to its low cost and high accessibility. However, more studies are needed to evaluate the efficacy, posology, duration and side‐effects of this treatment.