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Introduction <p>The purpose of this study was to evaluate the clinical outcomes of insulin eye drops in a real-world cohort of eyes affected by corneal persistent epithelial defects (PEDs) refractory to conventional therapy.</p> Methods <p>This retrospective study included consecutive patients with refractory PEDs treated with topical insulin (1&#xa0;IU/mL) four times daily. Clinical end points were: time to complete reepithelialization, cumulative probability of closure, longitudinal changes in defect area, postclosure complications, recurrence, and changes in best-corrected visual acuity (BCVA).</p> Results <p>A total of 45 eyes from 43 patients (mean age 64.6 ± 15.6&#xa0;years) were included. The most common etiology was chronic ocular surface diseases (62.2%) followed by neurotrophic keratopathy (37.8%). Complete epithelial closure was achieved in 44 of 45 eyes (97.8%), with a median time to closure of 29&#xa0;days (95%CI 24–38). The cumulative probability of complete reepithelialization was 20.0% at 14&#xa0;days, 53.3% at 30&#xa0;days, 90.5% at 60&#xa0;days, and 95.3% at 90&#xa0;days. A biphasic healing pattern was observed, with marked early reduction of the defect area progressively slowing over time (<i>p</i> &lt; 0.001). Median BCVA improved from 2.0 to 1.0 logMAR at epithelial closure (<i>p</i> &lt; 0.001). Two eyes (4.4%) experienced PED recurrence: one case regressed after first-line treatment while the other case progressed to corneal melting and ultimately required Gundersen flap surgery. No treatment-related adverse events were recorded.</p> Conclusions <p>Topical insulin may represent a safe, effective, and accessible therapeutic option for refractory PEDs, achieving high rates of complete reepithelialization with concomitant visual improvement and low short-term recurrence in a heterogeneous real-world cohort.</p>

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Topical Insulin for Corneal Persistent Epithelial Defects: A Multicenter Retrospective Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Filippo Lixi,
  • Alessandra Mancini,
  • Costanza Rossi,
  • Claudia Corda,
  • Benedetta Pintus,
  • Andrea Lucisano,
  • Federica Bianca,
  • Maura Mancini,
  • Mario Verdiglione,
  • Giulia Coco,
  • Mara Tomi,
  • Alina Gabriela Gheorghe,
  • Adriano Carnevali,
  • Vincenzo Scorcia,
  • Giuseppe Giannaccare

摘要

Introduction

The purpose of this study was to evaluate the clinical outcomes of insulin eye drops in a real-world cohort of eyes affected by corneal persistent epithelial defects (PEDs) refractory to conventional therapy.

Methods

This retrospective study included consecutive patients with refractory PEDs treated with topical insulin (1 IU/mL) four times daily. Clinical end points were: time to complete reepithelialization, cumulative probability of closure, longitudinal changes in defect area, postclosure complications, recurrence, and changes in best-corrected visual acuity (BCVA).

Results

A total of 45 eyes from 43 patients (mean age 64.6 ± 15.6 years) were included. The most common etiology was chronic ocular surface diseases (62.2%) followed by neurotrophic keratopathy (37.8%). Complete epithelial closure was achieved in 44 of 45 eyes (97.8%), with a median time to closure of 29 days (95%CI 24–38). The cumulative probability of complete reepithelialization was 20.0% at 14 days, 53.3% at 30 days, 90.5% at 60 days, and 95.3% at 90 days. A biphasic healing pattern was observed, with marked early reduction of the defect area progressively slowing over time (p < 0.001). Median BCVA improved from 2.0 to 1.0 logMAR at epithelial closure (p < 0.001). Two eyes (4.4%) experienced PED recurrence: one case regressed after first-line treatment while the other case progressed to corneal melting and ultimately required Gundersen flap surgery. No treatment-related adverse events were recorded.

Conclusions

Topical insulin may represent a safe, effective, and accessible therapeutic option for refractory PEDs, achieving high rates of complete reepithelialization with concomitant visual improvement and low short-term recurrence in a heterogeneous real-world cohort.