Low-Dose Insulin Useful for PEDs

Within a month, 31 out of 32 eyes with persistent epithelial defects in this study closure with either 1IU/mL or 10IU/mL insulin dosages.  Photo: Alan Kwok, OD. Click image to enlarge.  Previous studies have determined that topical insulin use was effective in accelerating epithelial defect closure in patients with refractory neurotrophic keratitis when compared to conventional treatment and may be highly advantageous due to its affordability and accessibility. They have noted that, when epithelialization is not achieved in two weeks with stan­dard initial treatment, this option would also seem like an effective and valid first-­line treatment option to avoid prolonging the re-epithelialization of persistent epithelial defects (PEDs) and the appearance of possible associated complications. A recent study presented at ARVO 2025 also evaluated the effectiveness of topical insulin in the treatment of persistent epithelial defects refractory to conventional treatment. Their study, based in Mexico City, found that topical insulin at a concentration of 1IU/mL appears to be a safe and effective therapeutic alternative to treat epithelial defects that don’t improve despite conventional treatment.A total of 32 eyes from 32 patients diagnosed with PEDs refractory to conventional treatments were randomly assigned to one of two treatment groups: insulin at a concentration of 1IU/mL or insulin at a concentration of 10IU/mL. Follow-up included taking photographs and measuring the area in mm2 using the ImageJ program on days zero, seven, 14, 21 and 28. Of the total sample, 31 eyes (96.8%) achieved closure of the epithelial defect with the prescribed treatment.Both doses were equally effective in resolving the epithelial defect in a similar time frame: the average closure time was 20.77 days for the 10IU/mL group and 17.50 days for the 1IU/mL group. The average closure time was shorter in the non-diabetic group (16.33 days) compared to the diabetic group (23.58 days), with a statistically significant difference. More than three-quarters (78.12%) of patients did not experience any adverse effects, while only 9.3% experienced burning and 6.25% reported pain. The most common etiology was attributed to intraocular surgery in 53.12% of cases.The researchers concluded in their abstract that “further studies are needed to compare this approach with other therapeutic options, using a larger patient sample and longer follow-up, to confirm these findings and establish more definitive treatment guidelines.”Original abstract content ©2025 Association for Research in Vision and Ophthalmology. Hernandez AJI, Gomez EA, Velasco R, et al. Effectiveness and safety of topical insulin in persistent epithelial defects refractory to treatment. ARVO 2025 annual meeting.