Randomized Clinical Trial of Topical Insulin Versus Artificial Tears for Healing Rates of Iatrogenic Corneal Epithelial Defects Induced During Vitreoretinal Surgery in Diabetics

Abstract

The aim of this study was to measure and compare the effect of topical insulin (0.5 units, 4 times per day) versus artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients.Methods: This is a double-blind randomized controlled hospitalbased study involving diabetic patients with postoperative corneal epithelial defects after vitreoretinal surgery. Diabetic patients were randomized into 2 different groups and received either 0.5 units of topical insulin (DTI) or artificial tears (Vismed, sodium hyaluronate 0.18%; DAT). The primary outcome measured was the rate of corneal epithelial wound healing (mm 2 /h) over a preset interval and time from baseline to minimum size of epithelial defect on fluorescein-stained anterior segment digital camera photography. The secondary outcome measured was the safety of topical insulin 0.5 units and artificial tears (Vismed, sodium hyaluronate 0.18%). Patients were followed up until 3 months postoperation.Results: A total of 38 eyes from 38 patients undergoing intraoperative corneal debridement during vitreoretinal surgery with resultant epithelial defects (19 eyes per group) were analyzed. DTI was observed to have a significantly higher healing rate compared with the DAT group at rates over 36 hours (P = 0.010), 48 hours (P = 0.009), and 144 hours (P = 0.009). The rate from baseline to closure was observed to be significantly higher in the DTI group (1.20 6 0.29) (mm 2 /h) compared with the DAT group (0.78 6 0.20) (mm 2 /h) as well (P , 0.001). No adverse effect of topical insulin and artificial tears was reported.Conclusions: Topical insulin (0.5 units, 4 times per day) is more effective compared with artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients, without any adverse events.

Evaluating the Safety and Efficacy of Topical Insulin for Ocular Disease: A Systematic Review

“…This in-depth evaluation ensured that only studies explicitly investigating the safety and efficacy of topical insulin for ocular disease were included. Ultimately, 10 articles (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) met the predefined inclusion criteria and were deemed worthy of further analysis and data extraction.…”

“…Reference: Dasrilsyah AM, et al 18 ; Purpose: “To measure and compare the effect of topical insulin (0.5 units, 4 times per day) versus artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients”; Type of study: Double-blind randomized controlled; Conclusion: “Topical insulin is more effective compared with artificial tears for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients, without any adverse events”.…”

Topical Insulin in Neurotrophic Keratopathy: A Review of Current Understanding of the Mechanism of Action and Therapeutic Approach

“…Initially, in the 1990s and early 2000s, high concentrations of insulin (25–100 IU/mL) were used. Even at high doses up to 100 IU/mL, insulin application was found to be safe [ 19 , 20 ]. The safety of higher concentrations indicates that they do not cause harm, but it does not imply greater efficacy.…”

“…The current preference for lower concentrations likely stems from proven efficacy in healing at lower doses, combined with a precautionary approach to minimize drug exposure and any potential, albeit low, toxicity. Thus, recent publications increasingly favor lower concentrations, typically 0.5–1 IU/mL [ 19 , 21 , 22 , 23 , 24 , 25 ]. This significant reduction in concentration still achieves clinical efficacy, but with presumably reduced drug toxicity [ 19 ].…”

“…Thus, recent publications increasingly favor lower concentrations, typically 0.5–1 IU/mL [ 19 , 21 , 22 , 23 , 24 , 25 ]. This significant reduction in concentration still achieves clinical efficacy, but with presumably reduced drug toxicity [ 19 ]. Dasrilsyah et al [ 19 ] found that topical insulin at a dosage of 0.5 units administered four times daily is superior in healing corneal epithelial defects in diabetic post-vitrectomy patients, compared with placebo or higher insulin concentrations (1 or 2 IU/mL).…”