Topical insulin for neurotrophic corneal ulcers

Tong, C. Maya; Iovieno, Alfonso; Yeung, Sonia N.

doi:10.1016/j.jcjo.2020.04.001

Cited by 20 publications

(15 citation statements)

References 13 publications

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“…In other studies, one to two insulin drops administered 4–6 times daily were recommended [ 7 , 21 , 30 ]. This is probably due to the pharmacodynamics of rapid-acting insulins when they are administered subcutaneously.…”

Section: Dosage and Treatment Efficacymentioning

confidence: 99%

“…A pathognomonic symptom of neurotrophic keratopathy is corneal hypoesthesia, which denotes diminished corneal sensation. This impairment can arise following viral corneal infections (e.g., HSV, VZV) in the context of systemic diseases (such as diabetes mellitus and multiple sclerosis) or can be due to iatrogenic causes such as corneal surgeries and posterior vitrectomies ( Table 1 and Table 2 ) [ 7 , 8 ]. Regardless of the cause, however, the clinical severity of neurotrophic keratopathy remains poorly elucidated, especially in terms of restoring corneal sensation [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

Jaworski,

Lorenc,

Leszczyński

et al. 2023

Pharmaceutics

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Neurotrophic keratopathy is a corneal disease characterized by impaired corneal innervation. It can lead to corneal epithelial defects, ulcerations, and perforations. Topical insulin has been shown to be effective in treating this disorder. Insulin is a growth factor that can promote corneal epithelial cell proliferation and migration. In addition, it can also inhibit corneal epithelial cell apoptosis. Topical insulin has previously been found to enhance corneal wound healing. This article reviews the current understanding of the mechanism of action of topical insulin in the treatment of neurotrophic keratopathy.

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Section: Dosage and Treatment Efficacymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Jaworski,

Lorenc,

Leszczyński

et al. 2023

Pharmaceutics

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show abstract

“…Recently, finger prick blood directly applied to the eye has also been discussed [44]. Topical insulin drops (25 IU/ml) have also been described to successfully manage refractory neurotrophic corneal ulcers unresponsive to conventional treatments [45][46][47].…”

Section: Medical Managementmentioning

confidence: 99%

Neurotrophic keratitis: inflammatory pathogenesis and novel therapies

Wajnsztajn,

Faraj,

Sanchez-Tabernero

et al. 2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Neurotrophic keratitis is a rare degenerative disease characterized by decrease or absence of corneal sensation. Neurotrophic keratitis varies from mild forms with mild epitheliopathy to severe manifestations such as corneal ulceration, melting and perforation that can lead to irreversible visual loss. The cause of neurotrophic keratitis comprises a long list of diseases, medications, congenital or genetic conditions as well as trauma. The mechanism of neurotrophic keratitis is complex and multifactorial and its understanding is crucial to better address the treatment strategies. We aimed to review neurotrophic keratitis pathology, mechanisms and management. Recent findings Corneal nerves are critical for the homeostasis of a healthy ocular surface. The lack of nerve-derived neuromediators and corneal-released neuropeptides, neuro-trophins and neurotrophic factors in neurotrophic keratitis leads to a decrease in trophic supply to corneal cells in addition to a decrease in afferent signaling to the brain. This results in pathological tear secretion, decreased blinking rate, corneal healing along with ocular surface and corneal inflammation. Lately, nerve growth factor in special gained emphasis as a treatment strategy targeting the disease mechanism rather than its manifestations. Other therapies, including surgical interventions, are in the pipeline of neurotrophic keratitis management. However, there are still no proper therapeutic guidelines and neurotrophic keratitis treatment remains challenging. Summary Neurotrophic keratitis may have a devastating outcome and treatment is still challenging. Understanding the disease pathology may assist in the development of new treatment strategies. Prompt disease recognition and immediate intervention are key factors to promote corneal healing and avoid further deterioration.

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“…53 Tong et al reported a case of bilateral refractory NK that showed substantial re-epithelialization 7 days after prescribing topical insulin (25 IU/mL, 6 times daily). 54 Other promising therapies include thymosin beta-4 and oral nicergoline. 55,56…”

Section: Managementmentioning

confidence: 99%

Neurotrophic Keratitis: A Review

Duncan¹,

Houser²,

Khandelwal³

2022

US Ophthalmic Review

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Impairment in trigeminal nerve function causes a loss of corneal sensation and can lead to neurotrophic keratitis (NK). This gradual deterioration in the surface integrity of the cornea predisposes to the development of ulcers and may even progress to perforation, posing a risk for profound vision loss. Many common ophthalmic and systemic conditions, such as herpetic infections, ocular surgeries, neurosurgical procedures, multiple sclerosis and diabetes, can elicit NK by injuring the trigeminal nerve. Disease progression can occur rapidly and without symptoms, therefore, detecting NK early is critical. Management aims to halt continuing corneal damage and promote epithelial cell healing and nerve fibre regeneration. Novel treatment options show promise in restoring corneal sensitivity by re-establishing innervation, targeting the fundamental source of NK.

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Topical insulin for neurotrophic corneal ulcers

Cited by 20 publications

References 13 publications

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

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

Neurotrophic keratitis: inflammatory pathogenesis and novel therapies

Neurotrophic Keratitis: A Review

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