Topical Insulin Effective Against Neurotrophic Keratopathy, Study Finds

A total of 23 eyes with Stage 2 or 3 neurotrophic keratopathy were treated with insulin and 18 completely healed during the trial, but five eyes failed to achieve the primary outcome. Instead, three of the remaining eyes progressed in ulcer size, one remained unchanged and the final subject improved but did not heal completely. Of the three progressive ulcer cases, two underwent tarsorrhaphy to resolve the defect, while the other had a progressive ulcer due to a secondary infection that required enucleation. Photo: Megan Mannen, OD. Click image to enlarge. Due to its wide accessibility, topical insulin has been proposed as an alternative to cenegermin to heal and repair corneal nerves in several small case studies. Positive outcomes were reported, but real-world results remained unknown, as most research has been limited to small samples. Canadian researchers recently analyzed the healing rate of insulin in a multietiological study of neurotrophic keratitis (NK) patients that also used a relatively low number of subjects.In their study, 29 eyes (28 patients) with NK were recruited and treated with insulin. Each patient was examined for preexisting etiologies, disease severity (Stages 1, 2 and 3), healing response and disease recurrence. Most subjects presented with infectious etiologies (51.7%) and either Stage 2 or 3 NK (79.3%).During the trial, the average follow-up time was 32.7 ±35.8 weeks; however, at week eight, researchers collected data on healing rates. At follow-up, NK patients experienced a healing rate of 78.3%, nearly double the rate observed during week eight (43.5%). Combined, the median healing time for patients was 33.5 days, but Stage 2 patients took longer. Healing took a median time of 59 days, while Stage 3 patients had a time of 21 days. Stage 1 eyes were not examined for their healing time.In some cases, subjects with Stage 2 and 3 NK reported previous therapies that failed. This group of 10 patients was categorized as the strict-refractory subgroup. Eyes in this group managed to fully heal with a median time of 63 days.“The ultimate healing rate of 78.3% in our stages 2 and 3 cohort compares favorably to cenegermin’s reported rates, suggesting that given adequate time, insulin achieves similar overall efficacy,” explained the researchers in their published paper. “Importantly, our 100% healing rate in the strict-refractory subgroup suggests insulin may be particularly valuable for patients who have exhausted standard options but cannot access or afford cenegermin.”Not every case was perfect, and there were successful cases where ocular issues occurred. Out of the 28 subjects, eight patients discontinued topical insulin after healing. Although most remained healthy, one case of recurrence was reported. Fortunately, it was resolved after the patient resumed treatment. Additionally, one patient developed mild punctate keratopathy during the study, but their condition resolved as the trial continued.“Further studies should aim to identify clinical characteristics or etiological predictions of strong responsiveness to insulin,” researchers concluded. “Furthermore, the variability in insulin concentrations across studies may also influence outcomes. More studies exploring dose-response relationships and corneal response to insulin type are needed to optimize patient care.” Click here for the journal source. Padda E, Hanafimosalman M, Racine L, et al. Real-world effectiveness of topical insulin for neurotrophic keratopathy: Retrospective case series of 29 eyes. Canadian Journal of Ophthalmology. February 4, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.