Recent research analyzed the clinical outcomes of patients with neurotrophic keratitis (NK) treated with topical insulin.
Give me some background first.
NK is a corneal degenerative disease characterized by a reduction or absence of corneal sensitivity that can lead to:
- Epithelial breakdown
- Impairment of healing
- Corneal ulceration, melting, and perforation
Now, talk about the study.
Researchers conducted a retrospective chart review of participants with NK that was resistant to traditional treatment methods. The participants were classified into two groups:
- Group 1
- Received insulin therapy with topical insulin at a concentration of 4 units per mL
- Group 2
- Received conventional treatment
Who was included in the study?
A total of 52 participants (52 eyes) were enrolled. Of these:
- 27 eyes were analyzed in Group 1
- 25 eyes were analyzed in Group 2
- Mean age of group 1: 61.70 ± 3.28 years
- Range: 55 to 68
- Mean age of Group 2: 62.04 ± 3.61 years
- Range: 55 to 69
Findings?
The investigators reported that:
- Mean time between diagnosis and start of treatment was longer in Group 1 than in Group 2
- 87.33 ± 142.57 vs. 35.20 ± 100.84 days (p = < 0.001)
- There were no differences in the baseline characteristics between groups (p>0.05)
- The final defect area was smaller in the insulin group
- 3.79 ± 1.76 vs. 11.89 ± 2.37, p = < 0.001
- There were no differences in recurrences, complications, and subsequent surgical interventions between groups (p > 0.05)
What were the findings for re-epithelialization?
Re-epithelialization was achieved in:
- 20 eyes (74%) in Group 1 (p > 0.05)
- 16 eyes (64%) in Group 2 (p > 0.05)
Mean time to re-epithelialization was:
- 32.25 ± 4.40 days for the insulin group (p = 0.000)
- 82.48 ± 6.84 days for the control (p = 0.000)
And the findings for VA?
Initial visual acuity (VA) before treatment was:
- 1.84 ± 1.02 logMAR for Group 1
- 1.77 ± 0.98 logMAR for Group 2
Mean VA improved to:
- 1.89 ± 1.07 logMAR for Group 1
- 1.56 ± 0.98 logMAR for Group 2
Note: There were no significant differences (p > 0.05) related to VA
Expert opinion?
Investigators noted that their results showed topical insulin may be effective in accelerating epithelial defect closure in individuals with refractory neurotrophic keratopathy when compared to conventional treatment and may be beneficial due to its affordable and accessible nature.
However, it is not free of complications and recurrences
Take home.
These findings suggest that topical insulin may be effective in accelerating epithelial defect closure in individuals with refractory neurotrophic keratopathy.
The authors stated: “This approach holds potential for improving the outcomes and management of neurotrophic keratitis, offering a new avenue for treating this challenging eye condition.”
This abstract was presented during the Association for Research in Vision and Ophthalmology (ARVO) meeting in Seattle Washington, May 5-9, 2024.