Topical insulin for neurotrophic corneal ulcers

Topical insulin for neurotrophic corneal ulcers

Neurotrophic keratitis (NK) is a degenerative corneal epithelial disease characterized by decreased corneal innervation,
causing epithelial breakdown and poor wound healing.13
NK may be a result of ocular infections or disorders, or secondary to systemic disorders.1,2,4 Affected corneas range from
mild (persistent epithelial defects and irregularities) to severe
disease (corneal melt and perforation).2 Neurotrophic ulcers
might be considered refractory when they are unresponsive to
conventional treatments. These include conservative measures, such as aggressive topical lubrication (nonpreserved artificial tears, ointments, or autologous serum drops), punctal
plugs, or use of a bandage contact lens, and surgical measures,
such as amniotic membrane graft, tarsorrhaphy, or penetrating or lamellar keratoplasty in the setting of corneal perforation.2 Many options, including amniotic membrane grafts,
autologous serum drops, and recombinant human nerve
growth factor (rhNGF), have significant costs to patients and
the health care system.2 Few case series describe using topical
insulin, which may be an effective and affordable option for
patients with refractory NK. In this report, we describe a case
of bilateral NK that was successfully treated with topical insulin and review the existing literature on the topic. The purpose of this discussion is to explore the utility of topical
insulin in the armamentarium for treatment of NK where
conventional methods have failed.