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Efficacy of topical insulin for recurrent epithelial corneal erosions

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Abstract

Background

Topical insulin can promote and accelerate corneal regeneration, even in eyes with serious comorbidities, and offers several benefits over other treatment options.

Aims

The aim of this study is to evaluate the effect of topical insulin in treatment of recurrent epithelial corneal erosion.

Methods

Patients with recurrent epithelial erosions were included in a prospective non-randomized hospital-based study, divided into two groups, one of them received persistent epithelial defects (PEDs) conventional treatment and the other received the same treatment with insulin eye drops 4 times/day. All patients were examined carefully by slit lamp. Patients during the 1st, 2nd, 3rd, and 4th weeks as well as after 2 months. Demographics, etiology, therapy, comorbidities, and the healing time of PED were performed.

Results

Area shows significant improvement after 2 weeks (p = 0.006), 2 months (p = 0.046), and 3 months (p = 0.002) in group II (cornetears gel and topical insulin) as compared to group I (cornetears gel). The recurrence was statistically significant decreased with cornetears gel and topical insulin (group II) by 0.0%, as compared to cornetears gel (group I) by 3 patients (21.4%).

Conclusion

Topical insulin can promote corneal reepithelization in recurrent epithelial erosion and decreases recurrence in these cases. Other advantages include excellent tolerance, availability, and cost-effectiveness.

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Data availability

The authors declare that all data supporting the findings of this study are available within the article and its supplementary information file.

References

  1. DelMonte DW, Kim T (2011) Anatomy and physiology of the cornea. J Cataract Refract Surg 37:588–598. https://doi.org/10.1016/j.jcrs.2010.12.037

    Article  PubMed  Google Scholar 

  2. Musa M, Zeppieri M, Enaholo ES et al (2023) An overview of corneal transplantation in the past decade. Clin Pract 13(1):264–279. https://doi.org/10.3390/clinpract13010024

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sridhar MS (2018) Anatomy of cornea and ocular surface. Indian J Ophthalmol 66(2):190–194. https://doi.org/10.4103/ijo.IJO_646_17

    Article  PubMed  PubMed Central  Google Scholar 

  4. Eghrari AO, Riazuddin SA, Gottsch JD (2015) Overview of the cornea: structure, function, and development. Prog Molecul Biol Translat Sci 134:7–23. https://doi.org/10.1016/bs.pmbts.2015.04.001

    Article  Google Scholar 

  5. Wilson SE, Medeiros CS, Santhiago MR (2018) Pathophysiology of corneal scarring in persistent epithelial defects after PRK and other corneal injuries. J Refract Surg 34(1):59–64. https://doi.org/10.3928/1081597X-20171128-01

    Article  PubMed  PubMed Central  Google Scholar 

  6. Vaidyanathan U, Hopping GC, Liu HY et al (2019) Persistent corneal epithelial defects: a review article. Med Hypothesis. Discov Innov Ophthalmol 8(3):163–176. PMID: 31598519; PMCID: PMC6778469

    PubMed  PubMed Central  Google Scholar 

  7. Guerra NP, Reifschneider E, Becker SL et al (2023) Recurrent corneal erosions related to an ocular injury 15 years before presentation. Am J Ophthalmol Case Rep. 29:101787. https://doi.org/10.1016/j.ajoc.2022.101787

    Article  Google Scholar 

  8. Nanba H, Mimura T, Mizuno Y et al (2019) Clinical course, and risk factors of recurrent corneal erosion: observational study. Medicine 98(16):e14964. https://doi.org/10.1097/MD.0000000000014964

    Article  PubMed  PubMed Central  Google Scholar 

  9. Balal S, Ansari AS, Sim PY et al (2023) The incidence and prevalence of recurrent corneal erosion syndrome in London. UK Eye 10:1–4. https://doi.org/10.1038/s41433-023-02490-3

    Article  Google Scholar 

  10. Diez-Feijóo E, Grau AE, Abusleme EI et al (2014) Clinical presentation and causes of recurrent corneal erosion syndrome: review of 100 patients. Cornea 33(6):571–575. https://doi.org/10.1097/ICO.0000000000000111

    Article  PubMed  Google Scholar 

  11. Suri K, Kosker M, Duman F et al (2013) Demographic patterns and treatment outcomes of patients with recurrent corneal erosions related to trauma and epithelial and bowman layer disorders. Americ J Ophthalmol 156(6):1082–1087. https://doi.org/10.1016/j.ajo.2013.07.022

    Article  Google Scholar 

  12. Yeu E, Hashem O, Sheha H (2022) Treatment of epithelial basement membrane dystrophy to optimize the ocular surface prior to cataract surgery. Clin Ophthalmol 1:785–795. https://doi.org/10.2147/OPTH.S356421

    Article  Google Scholar 

  13. Miller DD, Hasan SA, Simmons NL et al (2019) Recurrent corneal erosion: a comprehensive review. Clin Ophthalmol 13:325. https://doi.org/10.2147/OPTH.S157430

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fu-Shin XY, Yin J, Xu K et al (2010) Growth factors and corneal epithelial wound healing. Brain Res Bullet 81(2–3):229–235. https://doi.org/10.1016/j.brainresbull.2009.08.024

    Article  CAS  Google Scholar 

  15. Fai S, Ahem A, Mustapha M et al (2017) Randomized controlled trial of topical insulin for healing corneal epithelial defects induced during vitreoretinal surgery in diabetics. Asia-Pacific J Ophthalmol 6(5):418–424. https://doi.org/10.22608/APO.201780

  16. Wang AL, Weinlander E, Metcalf BM et al (2017) The use of topical insulin to treat refractory neurotrophic corneal ulcers. Cornea 36(11):1426. https://doi.org/10.1097/ICO.0000000000001297

    Article  PubMed  PubMed Central  Google Scholar 

  17. Galvis V, Niño CA, Tello A et al (2019) Topical insulin in neurotrophic keratopathy after resection of acoustic neuroma. Arch Soc Esp Oftalmol 94(2):100–104. https://doi.org/10.1016/j.oftal.2018.06.003

    Article  CAS  PubMed  Google Scholar 

  18. Katzman LR, Jeng BH (2014) Management strategies for persistent epithelial defects of the cornea. Saudi J Ophthalmol 28(3):168–172. https://doi.org/10.1016/j.sjopt.2014.06.011

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jeng BH, Dupps WJ (2009) Autologous serum 50% eyedrops in the treatment of persistent corneal epithelial defects. Cornea 28(10):1104–1108. https://doi.org/10.1097/ICO.0b013e3181a2a7f6

    Article  PubMed  Google Scholar 

  20. Zagon IS, Klocek MS, Sassani JW et al (2007) Use of topical insulin to normalize corneal epithelial healing in diabetes mellitus. Arch Ophthalmol 125(8):1082–1088. https://doi.org/10.1001/archopht.125.8.1082

    Article  CAS  PubMed  Google Scholar 

  21. Titone R, Zhu M, Robertson DM (2018) Insulin mediates de novo nuclear accumulation of the IGF-1/insulin hybrid receptor in corneal epithelial cells. Sci Rep 8(1):1–3. https://doi.org/10.1038/s41598-018-21031-7

    Article  CAS  Google Scholar 

  22. Diaz-Valle D, Burgos-Blasco B, Gegundez-Fernandez JA et al (2021) Topical insulin for refractory persistent corneal epithelial defects. Europ J Ophthalmol 31(5):2280–2286. https://doi.org/10.1177/1120672120958307

    Article  Google Scholar 

  23. Bastion ML, Ling KP (2013) Topical insulin for healing of diabetic epithelial defects: a retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients. Med J Malaysia 68(3):208–216. PMID: 23749008

    CAS  PubMed  Google Scholar 

  24. Ramamurthi S, Rahman MQ, Dutton GN et al (2006) Pathogenesis, clinical features, and management of recurrent corneal erosion. Eye 20(6):635–644. https://doi.org/10.1038/sj.eye.6702005

    Article  CAS  PubMed  Google Scholar 

  25. Stuard WL, Titone R, Robertson DM (2020) The IGF/insulin-IGFBP axis in corneal development, wound healing, and disease. Frontiers Endocrinol 11(24):1–15. https://doi.org/10.3389/fendo.2020.00024

    Article  Google Scholar 

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Authors and Affiliations

  1. Ophthalmology Department, Faculty of Medicine, Menoufia University, Menoufia, Shebin El Kom, Egypt

    Ahmed Esmail & Sara Nage

  2. Ophthalmology Department, Faculty of Medicine, Kafrelshiekh University Hospital, Kafrelshiekh, Egypt

    Mohamed Ibrahim

Authors
  1. Ahmed Esmail
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  2. Mohamed Ibrahim
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  3. Sara Nage
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Corresponding author

Correspondence to Ahmed Esmail.

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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

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The authors declare no competing interests.

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Esmail, A., Ibrahim, M. & Nage, S. Efficacy of topical insulin for recurrent epithelial corneal erosions. Ir J Med Sci 192, 3117–3123 (2023). https://doi.org/10.1007/s11845-023-03373-y

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  • DOI: https://doi.org/10.1007/s11845-023-03373-y

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