Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathy
Purpose: To report the clinical outcomes achieved in refractory cases of neurotrophic keratopathy (NK) through the utilization of insulin eye drops alone or in conjunction with a drug-depository contact lens (DDCL). Observations: This multicentric prospective open-label uncontrolled case series incl...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993624002378 |
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| author | Alessandra Mancini Maura Mancini Andrea Taloni Luca Bifezzi Maria Angela Romeo Lorenzo Rijillo Mario Verdiglione Vincenzo Scorcia Pasquale Aragona Giuseppe Giannaccare |
| author_facet | Alessandra Mancini Maura Mancini Andrea Taloni Luca Bifezzi Maria Angela Romeo Lorenzo Rijillo Mario Verdiglione Vincenzo Scorcia Pasquale Aragona Giuseppe Giannaccare |
| author_sort | Alessandra Mancini |
| collection | DOAJ |
| description | Purpose: To report the clinical outcomes achieved in refractory cases of neurotrophic keratopathy (NK) through the utilization of insulin eye drops alone or in conjunction with a drug-depository contact lens (DDCL). Observations: This multicentric prospective open-label uncontrolled case series included consecutive patients with NK refractory to conventional treatment. Insulin eye drops (1 unit/mL) were prescribed 4 times/day in all cases, and a Therapeutic Hyper-CL™ soft contact lens (EyeYon Medical, Ness Ziona, Israel), designed to act as a drug reservoir, was applied in selected patients. Data about stage and duration of NK, corneal sensitivity, previous treatments, rate and speed of healing, changes of NK area over time were collected. Nine eyes of 8 patients (mean age 52.50 ± 12.03 years [95 % CI, 44.13–60.87]) affected by NK refractory to conventional medical therapy were included. All patients received topical insulin, while DDCL was also applied in 3 cases. At T0, the mean area of the corneal epithelial defect was 21.84 ± 18.35 mm2 [95 % CI, 9.86–33.84]. Complete corneal re-epithelialization occurred in all cases, after a mean time interval of 25.78 ± 8.39 days [95 % CI, 20.30–31.26]. Mean reduction rate of epithelial defect areas was −0.81 ± 0.44 mm2/day [95 % CI, −1.16 to −0.46] for patients treated with insulin eye drops, and −0.63 ± 0.30 mm2/day [95 % CI, −0.96 to −0.29] for those treated with insulin eye drops plus DDCL (p = 0.71). Neither adverse events nor episodes of NK recurrence were reported. Conclusions and importance: Topical insulin, used alone or in combination with DDCL, is an accessible, inexpensive, and effective treatment for refractory NK. |
| format | Article |
| id | doaj-art-a37f4e48b4a74dc3a3523eb7911fe653 |
| institution | OA Journals |
| issn | 2451-9936 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj-art-a37f4e48b4a74dc3a3523eb7911fe6532025-08-20T01:57:52ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362024-12-013610222710.1016/j.ajoc.2024.102227Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathyAlessandra Mancini0Maura Mancini1Andrea Taloni2Luca Bifezzi3Maria Angela Romeo4Lorenzo Rijillo5Mario Verdiglione6Vincenzo Scorcia7Pasquale Aragona8Giuseppe Giannaccare9Department of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, 88100, ItalyDepartment of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, 98122, ItalyDepartment of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, 88100, ItalyDepartment of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, 88100, ItalyDepartment of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, 88100, ItalyDepartment of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, 88100, ItalyCompounding Pharmacy, Farmacia Europea, Catanzaro, 88100, ItalyDepartment of Ophthalmology, University Magna Graecia of Catanzaro, Catanzaro, 88100, ItalyDepartment of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, 98122, ItalyEye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, 09124, Italy; Corresponding author. Department of Surgical Sciences, University of Cagliari, Via Università 40, 09124, Cagliari, Italy.Purpose: To report the clinical outcomes achieved in refractory cases of neurotrophic keratopathy (NK) through the utilization of insulin eye drops alone or in conjunction with a drug-depository contact lens (DDCL). Observations: This multicentric prospective open-label uncontrolled case series included consecutive patients with NK refractory to conventional treatment. Insulin eye drops (1 unit/mL) were prescribed 4 times/day in all cases, and a Therapeutic Hyper-CL™ soft contact lens (EyeYon Medical, Ness Ziona, Israel), designed to act as a drug reservoir, was applied in selected patients. Data about stage and duration of NK, corneal sensitivity, previous treatments, rate and speed of healing, changes of NK area over time were collected. Nine eyes of 8 patients (mean age 52.50 ± 12.03 years [95 % CI, 44.13–60.87]) affected by NK refractory to conventional medical therapy were included. All patients received topical insulin, while DDCL was also applied in 3 cases. At T0, the mean area of the corneal epithelial defect was 21.84 ± 18.35 mm2 [95 % CI, 9.86–33.84]. Complete corneal re-epithelialization occurred in all cases, after a mean time interval of 25.78 ± 8.39 days [95 % CI, 20.30–31.26]. Mean reduction rate of epithelial defect areas was −0.81 ± 0.44 mm2/day [95 % CI, −1.16 to −0.46] for patients treated with insulin eye drops, and −0.63 ± 0.30 mm2/day [95 % CI, −0.96 to −0.29] for those treated with insulin eye drops plus DDCL (p = 0.71). Neither adverse events nor episodes of NK recurrence were reported. Conclusions and importance: Topical insulin, used alone or in combination with DDCL, is an accessible, inexpensive, and effective treatment for refractory NK.http://www.sciencedirect.com/science/article/pii/S2451993624002378Insulin eye dropsHyper-CLNeurotrophic keratopathyNKPersistent epithelial defect |
| spellingShingle | Alessandra Mancini Maura Mancini Andrea Taloni Luca Bifezzi Maria Angela Romeo Lorenzo Rijillo Mario Verdiglione Vincenzo Scorcia Pasquale Aragona Giuseppe Giannaccare Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathy American Journal of Ophthalmology Case Reports Insulin eye drops Hyper-CL Neurotrophic keratopathy NK Persistent epithelial defect |
| title | Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathy |
| title_full | Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathy |
| title_fullStr | Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathy |
| title_full_unstemmed | Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathy |
| title_short | Topical insulin used alone or in combination with drug-depository contact lens for refractory cases of neurotrophic keratopathy |
| title_sort | topical insulin used alone or in combination with drug depository contact lens for refractory cases of neurotrophic keratopathy |
| topic | Insulin eye drops Hyper-CL Neurotrophic keratopathy NK Persistent epithelial defect |
| url | http://www.sciencedirect.com/science/article/pii/S2451993624002378 |
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