Moin Kayvon A, Pandiri Srujay, Manion Garrett N, Brown Alex H, Moshirfar Majid, Hoopes Phillip C
Hoopes Vision Research Center, Hoopes Vision, Draper, USA.
Ophthalmology, University of Missouri Kansas City School of Medicine, Kansas City, USA.
Cureus. 2024 Jun 10;16(6):e62065. doi: 10.7759/cureus.62065. eCollection 2024 Jun.
Various etiologies, including diabetic keratopathy (DK), dry eye disease (DED), and neurotrophic keratopathy (NK), can disrupt corneal homeostasis, exacerbating corneal epithelial defects. Topical insulin has emerged as a promising therapy for promoting corneal wound healing and addressing underlying pathologies. This review systematically evaluates the efficacy of topical insulin across different corneal disorders. A literature review was conducted across the PubMed, Google Scholar, and Scopus research databases. The search resulted in a total of 19 articles, consisting of clinical trials, retrospective studies, and case reports. In DK, topical insulin accelerates corneal wound healing post-vitreoretinal surgery with lower concentrations showing higher outcomes when compared to conventional therapy, possibly due to improved epithelial stem cell migration. In comparison, the dry-eye disease results are inconclusive regarding patient-reported outcomes and corneal staining. For NK, topical insulin accelerates corneal wound healing and restores corneal nerve sensation. Other persistent epithelial defect (PED) etiologies that have been treated with topical insulin are infection, immune-mediated, mechanical and chemical trauma, and chronic ocular surface alterations. Although individual mechanisms for the benefits of topical insulin for each of these etiologies have not been studied, the literature demonstrates that topical insulin is efficacious for PEDs regardless of etiology. Future clinical trials need to be conducted to further evaluate optimal dosing, duration, and use of topical insulin for the restoration of the corneal surface.
包括糖尿病性角膜病变（DK）、干眼疾病（DED）和神经营养性角膜病变（NK）在内的多种病因，均可破坏角膜稳态，加剧角膜上皮缺损。局部应用胰岛素已成为促进角膜伤口愈合和解决潜在病理问题的一种有前景的治疗方法。本综述系统评估了局部应用胰岛素治疗不同角膜疾病的疗效。我们在PubMed、谷歌学术和Scopus研究数据库中进行了文献综述。检索共得到19篇文章，包括临床试验、回顾性研究和病例报告。在糖尿病性角膜病变中，局部应用胰岛素可加速玻璃体视网膜手术后的角膜伤口愈合，与传统治疗相比，较低浓度的胰岛素显示出更好的效果，这可能是由于上皮干细胞迁移得到改善。相比之下，关于干眼疾病患者报告的结果和角膜染色，结果尚无定论。对于神经营养性角膜病变，局部应用胰岛素可加速角膜伤口愈合并恢复角膜神经感觉。其他已用局部胰岛素治疗的持续性上皮缺损（PED）病因包括感染、免疫介导、机械和化学创伤以及慢性眼表改变。尽管尚未研究局部应用胰岛素对这些病因各自有益的具体机制，但文献表明，无论病因如何，局部应用胰岛素对持续性上皮缺损均有效。未来需要进行临床试验，以进一步评估局部应用胰岛素恢复角膜表面的最佳剂量、持续时间和使用方法。
