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Krolo I, Behaegel J, Termote K, de Bruyn B, De Schepper M, Oellerich S, Ní Dhubhghaill S. The role of topical insulin in ocular surface restoration: A review. Surv Ophthalmol 2024; 69:805-817. [PMID: 38609022 DOI: 10.1016/j.survophthal.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
Corneal epithelial defects are one of the most common ocular disorders. Restoring corneal integrity is crucial to reduce pain and regain function, but in cases of neurotrophic or desensitized corneas, healing can be significantly delayed. Treating neurotrophic corneas is challenging for ophthalmologists, and surgical intervention is often indicated to manage refractory cases that are unresponsive to medical therapy. Over the last decade, as more expensive therapeutics reach the market, topical insulin has returned to the forefront as an affordable option to improve corneal wound healing. There is still a paucity of data on the use and the efficacy of topical insulin, with no consensus regarding its indications, preparation, or posology. Here we review the literature on topical insulin for corneal and ocular surface pathologies, with a focus on the current evidence, its mechanisms of action, and its safety profile. Additionally, we share our experience in the field and provide a potential framework for future research.
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Affiliation(s)
- Iva Krolo
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Oftalmología Médica y Quirúrgica (OMIQ) Research, Barcelona, Spain.
| | - Joséphine Behaegel
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karolien Termote
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Ophthalmology, Imelda Hospital, Bonheiden, Belgium
| | - Barbara de Bruyn
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Manon De Schepper
- Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Silke Oellerich
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sorcha Ní Dhubhghaill
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
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2
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Moin KA, Pandiri S, Manion GN, Brown AH, Moshirfar M, Hoopes PC. The Utilization of Topical Insulin for Ocular Surface Diseases: A Narrative Review. Cureus 2024; 16:e62065. [PMID: 38989397 PMCID: PMC11235153 DOI: 10.7759/cureus.62065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
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.
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Affiliation(s)
- Kayvon A Moin
- Hoopes Vision Research Center, Hoopes Vision, Draper, USA
| | - Srujay Pandiri
- Ophthalmology, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Garrett N Manion
- Ophthalmology, Creighton University School of Medicine, Omaha, USA
| | - Alex H Brown
- Ophthalmology, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Majid Moshirfar
- Eye Banking and Corneal Transplantation, Utah Lions Eye Bank, Murray, USA
- Corneal and Refractive Surgery, Hoopes Vision Research Center, Draper, USA
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Cid-Bertomeu P, Vilaltella M, Martínez M, Mir M, Huerva V. Topical Insulin for Ocular Surface Disease. J Ocul Pharmacol Ther 2024; 40:204-214. [PMID: 38527183 DOI: 10.1089/jop.2024.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background: Insulin and insulin-like growth factor (IGF)-1 receptors are present in ocular tissues such as corneal epithelium, keratocytes, and conjunctival cells. Insulin plays a crucial role in the growth, differentiation, and proliferation of corneal epithelial cells, as well as in wound healing processes in various tissues. Purpose: This review explores the potential role of topical insulin in the treatment of ocular surface diseases. Specifically, it examines its impact on corneal nerve regeneration, sub-basal plexus corneal nerves, and its application in conditions like corneal epithelial defects, dry eye disease, and diabetic keratopathy. Methods: The review analyzes studies conducted over the past decade that have investigated the use of topical insulin in ocular surface diseases. It focuses on indications, drug preparation methods, side effects, efficacy outcomes, and variations in insulin concentrations and dosages used. Results: While off-label use of topical insulin has shown promising results in refractory corneal epithelial defects, its efficacy in dry eye disease is yet to be demonstrated. Variations in concentrations, dilutions, and dosing guidelines have been reported. However, limited data on ocular penetration, ocular toxicity, and systemic side effects pose challenges to its widespread utility. Conclusion: This review synthesizes findings from ocular investigations on topical insulin to assess its potential applicability in treating ocular surface and corneal diseases. By highlighting indications, preparation methods, side effects, and efficacy outcomes, it aims to provide insights into the current status and future prospects of using topical insulin in ophthalmic practice.
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Affiliation(s)
- Pau Cid-Bertomeu
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Magí Vilaltella
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
- School of Medicine, University of Lleida, Lleida, Spain
| | - Mireia Martínez
- Department of Hospital Pharmacy, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Marta Mir
- Department of Hospital Pharmacy, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Valentín Huerva
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
- School of Medicine, University of Lleida, Lleida, Spain
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Brockmann T, Simon A, Brockmann C, Fuchsluger TA, Pleyer U, Walckling M. [Corneal wound healing-Pharmacological treatment]. DIE OPHTHALMOLOGIE 2024; 121:245-258. [PMID: 38411733 DOI: 10.1007/s00347-024-02021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/28/2024]
Abstract
Physiological wound healing of the cornea is a complex process and involves numerous multifactorial tissue processes. A proper wound healing, especially without the formation of light-scattering scars, is essential to preserve the integrity and function of the cornea. Misdirected wound healing is of vast clinical relevance as it can lead to corneal fibrosis and the loss of optical transparency with subsequent reduction of visual acuity, up to blindness. In addition to the understanding of the pathophysiological mechanisms, the knowledge of therapeutic concepts and options for treating corneal wound healing disorders and fibrosis is essential to counteract a permanent damage of the cornea as early as possible. Nowadays, various pharmacological and surgical options are available for treatment. The decision, appropriate selection and indication for the optimal treatment depend primarily on the genesis and clinical appearance of the corneal wound, fibrosis or scar. The treatment of wound healing disorders ranges from the use of topical therapy and supportive measures up to tissue replacement procedures. As long as the mechanical stability of the cornea is intact and wound healing processes are still ongoing, a pharmacological modulation is reasonable, which is discussed in this article.
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Affiliation(s)
- Tobias Brockmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland.
- Fachbereich SciTec, Ernst-Abbe-Hochschule Jena, Carl-Zeiss-Promenade 2, 07745, Jena, Deutschland.
| | - Alexander Simon
- Fachbereich SciTec, Ernst-Abbe-Hochschule Jena, Carl-Zeiss-Promenade 2, 07745, Jena, Deutschland
| | - Claudia Brockmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland
| | - Thomas A Fuchsluger
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland
| | - Uwe Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Marcus Walckling
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland
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Woronkowicz M, Roberts H, Skopiński P. The Role of Insulin-like Growth Factor (IGF) System in the Corneal Epithelium Homeostasis-From Limbal Epithelial Stem Cells to Therapeutic Applications. BIOLOGY 2024; 13:144. [PMID: 38534414 DOI: 10.3390/biology13030144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
The corneal epithelium, comprising three layers of cells, represents the outermost portion of the eye and functions as a vital protective barrier while concurrently serving as a critical refractive structure. Maintaining its homeostasis involves a complex regenerative process facilitated by the functions of the lacrimal gland, tear film, and corneal nerves. Crucially, limbal epithelial stem cells located in the limbus (transitional zone between the cornea and the conjunctiva) are instrumental for the corneal epithelium integrity by replenishing and renewing cells. Re-epithelialization failure results in persistent defects, often associated with various ocular conditions including diabetic keratopathy. The insulin-like growth factor (IGF) system is a sophisticated network of insulin and other proteins essential for numerous physiological processes. This review examines its role in maintaining the corneal epithelium homeostasis, with a special focus on the interplay with corneal limbal stem cells and the potential therapeutic applications of the system components.
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Affiliation(s)
- Małgorzata Woronkowicz
- NDDH, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple EX31 4JB, UK
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Harry Roberts
- West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, UK
- University of Exeter Medical School, Exeter EX1 2HZ, UK
| | - Piotr Skopiński
- Department of Ophthalmology, SPKSO Ophthalmic University Hospital, Medical University of Warsaw, 00-576 Warsaw, Poland
- Department of Histology and Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland
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Jaworski M, Lorenc A, Leszczyński R, Mrukwa-Kominek E. Topical Insulin in Neurotrophic Keratopathy: A Review of Current Understanding of the Mechanism of Action and Therapeutic Approach. Pharmaceutics 2023; 16:15. [PMID: 38276493 PMCID: PMC10818503 DOI: 10.3390/pharmaceutics16010015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Neurotrophic keratopathy is a corneal disease characterized by impaired corneal innervation. It can lead to corneal epithelial defects, ulcerations, and perforations. Topical insulin has been shown to be effective in treating this disorder. Insulin is a growth factor that can promote corneal epithelial cell proliferation and migration. In addition, it can also inhibit corneal epithelial cell apoptosis. Topical insulin has previously been found to enhance corneal wound healing. This article reviews the current understanding of the mechanism of action of topical insulin in the treatment of neurotrophic keratopathy.
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Affiliation(s)
- Marcin Jaworski
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
- OPTOMED Ophthalmological Center for Children and Adults, 41-500 Chorzów, Poland
| | - Anna Lorenc
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Rafał Leszczyński
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
| | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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