TOPICAL INSULIN FOR HERPES SIMPLEX VIRUS NEUROTROPHIC KERATOPATHY - WHEN THE END-STAGE IS NOT “THE END”
Published 2025 - 29th ESCRS Winter Meeting
Reference: PO102 | Type: Free Paper | DOI: 10.82333/h6by-j112
Authors: Julia N. Widmer-Pintos* 1 , Mercè Guarro 2 , Iva Krolo 3
1Ophthalmology,Granollers General Hospital,Granollers,Spain, 2Ophthalmology,Granollers General Hospital,Granollers,Spain;Ophthalmology,Oftalmología Médica y Quirúrgica (OMIQ) Research,Barcelona,Spain, 3Ophthalmology,Granollers General Hospital,Granollers,Spain;Ophthalmology,Oftalmología Médica y Quirúrgica (OMIQ) Research,Barcelona,Spain;Ophthalmology,Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB),Brussels,Belgium
Purpose
To evaluate the clinical outcome of topical insulin treatment in eyes with stage 3 neurotrophic keratopathy (NK) due to prior herpes simplex virus (HSV) infection.
Setting
Department of Ophthalmology, Granollers General Hospital, Granollers (Barcelona), Spain
Methods
This retrospective case series includes 4 eyes of 4 patients with stage 3 of HSV-related NK according to the Mackie classification, treated with 1 IU/mL topical insulin drops 4 times daily after being referred to a cornea specialist. Prior to topical insulin use, their persistent epithelial defects (PEDs) were present for 7 to 30 days. All patients underwent a complete ophthalmological examination at baseline: slit lamp biomicroscopy, corneal sensitivity testing (Brill Corneal Esthesiometer, BRILL ENGINES S.L., Barcelona, Spain), anterior segment photography (Topcon DC-4, Topcon Healthcare, Oakland, USA) before and after fluorescein dye staining (analysed with ImageJ software), and best corrected visual acuity testing. The primary outcome of the study was the time until complete resolution of the PED once treatment with topical insulin was started. Secondary outcomes included visual acuity change and treatment safety profile.
Results
Mean age was 88.25 years. Corneal sensitivity measurement was level 5 in all patients (10 mbar pressure). All eyes achieved complete corneal wound closure, with a mean time of 30.2 [21-38] days. All four patients experienced a statistically insignificant increase in their BCVA, primarily limited due to their residual corneal scarring and overall visual potential. No side effects or serious adverse events were reported during follow-up. Patients reported good treatment tolerability and overall satisfaction profiles.
Conclusion
Our experience suggests topical insulin drops may be an effective therapeutic option for HSV-related, end-stage NK. Given its good safety profile, efficacy, cost-effectiveness and easy administration, topical insulin drops may be a viable option for epithelial wound healing in eyes with HSV keratopathy.