In Patients with Diabetes, Insulin Eye Drops Speed Post-op Corneal Wound Healing

According to this small Malaysian study, patients with diabetes may experience faster closure of corneal epithelial defects following vitreoretinal surgery if they are prescribed topical insulin rather than artificial tears postoperatively.

Study Design

This double-masked, prospective, randomized study evaluated the healing of corneal epithelial defects that occurred following vitreoretinal surgery in 38 patients (38 eyes) with diabetes. Nineteen patients were included in each treatment group. Defects were treated with either topical insulin (0.5 units) or topical artificial tears 4 times per day until complete epithelial healing was observed, with healing monitored every 12 hours through postoperative day 3 and once on day 6; patients were also followed up at months 1 and 3 postoperatively. All patients received a standard postoperative antibiotic and steroid regimen. Patients with underlying ocular surface disease and those using chronic topical drops were excluded.

Outcomes

In the insulin group, all epithelial defects were healed by day 3. In comparison, only 17 of 19 defects in the artificial tears group were healed by day 6, with 2 patients needing bandage contact lens placement at that time due to incomplete healing. The mean epithelial defect size was also consistently smaller at each measured time point through day 3 in the insulin group compared to the artificial tears group. No adverse effects from the treatments were seen in either cohort.

Limitations

Limitations of this study include the small number of patients and single-center approach. In addition, there is a lack of comparison to healing rates using other treatments, such as treatment with ointment in addition to artificial tears.

Clinical Significance

Patients with diabetes often experience delayed healing and are at higher risk of persistent corneal epithelial defects, which increases their risk of infectious keratitis and corneal scarring. However, surgical removal of the corneal epithelium is a required part of some corneal surgeries and may also improve the view through the cornea during vitreoretinal surgery. Having a safe and effective treatment option for patients with diabetes that can improve corneal healing in eyes with epithelial defects, such as topical insulin, is important for decreasing the likelihood of persistent defects and associated complications in these patients.

Financial Disclosures: Dr. Afshan Nanji discloses a financial relationship with Beyeonics Surgical (Consultant/Advisor).