The Performance of Topical Insulin in Persistent Corneal Epithelial Defects and Persistent Corneal Ulcers – A Case Series

To retrospectively describe the performance of topical insulin in persistent corneal epithelial defects (CED) and persistent corneal ulcers. We reviewed cases of patients treated for persistent CED and persistent corneal ulcers using topical insulin in a concentration of 25 IU per milliliter three times per day. The closure rate of CED and corneal ulcers was the main outcome measure. Thirty-seven episodes of 29 patients treated with topical insulin were reviewed. There was a wide range of additionally used medication, underlying pathologies as well as ocular and systemic comorbidities in our cohort. On average, insulin drops were started after 36 days of conventional therapy (SD 59, range 0–193) and were used for 42 days (SD 38, range 3–130). Therapy success was achieved in 15 of 28 (53.5%) cases with CED and in 4 of 9 (44%) cases with corneal ulcers. While insulin generally showed a good safety profile, one patient reported intolerable discomfort related to the use of topical insulin. Topical insulin may be considered as a treatment option in complicated cases refractory to conventional treatment, but outcomes may be less favorable than previously reported.