Revista Mexicana de Oftalmología

Register      Login

VOLUME 95 , ISSUE 2E ( March-April, 2021 ) > List of Articles

Original Article

Clinical trial of topical insulin and sodium hyaluronate in the treatment of epithelial defects produced by intraoperative corneal epithelial debridement during pars plana vitrectomy in diabetics

Jaime L. Quiroz-Mendoza, Marlon García-Roa, Verónica Romero-Morales, Diego Valera-Cornejo, Miguel Vázquez-Membrillo, Paulina Ramírez-Neria, Yolanda Villalpando-Gómez, Renata García-Franco

Keywords : Diabetes mellitus, Corneal epithelium, Sodium hyaluronate, Insulin, Diabetic retinopathy, Vitrectomy

Citation Information : Quiroz-Mendoza JL, García-Roa M, Romero-Morales V, Valera-Cornejo D, Vázquez-Membrillo M, Ramírez-Neria P, Villalpando-Gómez Y, García-Franco R. Clinical trial of topical insulin and sodium hyaluronate in the treatment of epithelial defects produced by intraoperative corneal epithelial debridement during pars plana vitrectomy in diabetics. 2021; 95 (2E):60-67.

DOI: 10.24875/RMOE.M21000157

License: CC BY-NC-ND 4.0

Published Online: 16-03-2021

Copyright Statement:  Copyright © 2020 Sociedad Mexicana de Oftalmología. Published by Permanyer


Abstract

Purpose: To compare the effect of topical insulin and sodium hyaluronate in the treatment of epithelial defects secondary to intraoperative corneal epithelial debridement during pars plana vitrectomy in diabetics. Methods: Controlled clinical trial. Patients were randomized to one of three treatment groups: topical 0.15% sodium hyaluronate (group I), topical insulin 0.5 IU/drop (group II) or combined treatment with topical insulin 0.5 IU/drop and 0.15% sodium hyaluronate (group III). Results: Thirty-six eyes of 36 patients were included, 12 eyes in each group. There were no statistically significant differences in baseline characteristics. The time required until complete re-epithelialization was of 4.25 ± 0.62, 3.0 ± 0.85 and 3.33 ± 0.98 days, in groups I, II and III, respectively; group II showed a significantly shorter reepithelialization time (p < 0.001). All groups had a reduction in the area of the epithelial defect from day 1; a smaller area was observed in group II; however, this difference was not statistically significant. No adverse effects were reported. Conclusions: Both topical insulin and combined treatment with topical insulin and sodium hyaluronate are effective to treat corneal epithelial defects secondary to intraoperative corneal epithelial debridement during pars plana vitrectomy in diabetics. The addition of sodium hyaluronate to topical insulin did not provide a greater benefit. The three treatments were safe and well tolerated.


PDF Share
  1. Hiraoka M, Amano S, Oshika T, Kato S, Hori S. Factors contributing to corneal complications after vitrectomy in diabetic patients. Jpn J Ophthalmol. 2001;45:492-5.
  2. Chiang W-Y, Lee J-J, Kuo H-K, Chen Y-H, Chen C-H, Chen Y-J, et al. Factors associated with corneal epithelial defects after pars plana vitrectomy. Int Ophthalmol. 2018;38:105-10.
  3. Chen H-F, Yeung L, Yang K-J, Sun C-C. Persistent corneal epithelial defect after pars plana vitrectomy. Retina Phila Pa. 2016;36:148-55.
  4. Wang Y, Zhou Q, Xie L. [Diabetic keratopathy: new progresses and challenges]. Zhonghua Yan Ke Za Zhi Chin J Ophthalmol. 2014;50:69-72.
  5. Matsumura T, Takamura Y, Tomomatsu T, Arimura S, Gozawa M, Takihara Y, et al. Changes in matrix metalloproteinases in diabetes patients' tears after vitrectomy and the relationship with corneal epithelial disorder. Invest Ophthalmol Vis Sci. 2015;56:3559-64.
  6. Friberg TR, Ohji M, Scherer JJ, Tano Y. Frequency of epithelial debridement during diabetic vitrectomy. Am J Ophthalmol. 2003;135:553-4.
  7. Fai S, Ahem A, Mustapha M, Mohd Noh UK, Bastion M-LC. Randomized controlled trial of topical insulin for healing corneal epithelial defects induced during vitreoretinal surgery in diabetics. Asia-Pac J Ophthalmol Phila Pa. 2017;6:418-24.
  8. Zagon IS, Klocek MS, Sassani JW, McLaughlin PJ. Use of topical insulin to normalize corneal epithelial healing in diabetes mellitus. Arch Ophthalmol 2007;125:1082-8.
  9. Bartlett JD, Turner-Henson A, Atchison JA, Woolley TW, Pillion DJ. Insulin administration to the eyes of normoglycemic human volunteers. J Ocul Pharmacol. 1994;10:683-90.
  10. Bartlett JD, Slusser TG, Turner-Henson A, Singh KP, Atchison JA, Pillion DJ. Toxicity of insulin administered chronically to human eye in vivo. J Ocul Pharmacol. 1994;10:101-7.
  11. Wang AL, Weinlander E, Metcalf BM, Barney NP, Gamm DM, Nehls SM, et al. The use of topical insulin to treat refractory neurotrophic corneal ulcers. Cornea. 2017;36:1426-8.
  12. Bastion MLC, Ling KP. Topical insulin for healing of diabetic epithelial defects? A retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients. Med J Malaysia. 2013;68:208-16.
  13. Chikama T, Wakuta M, Liu Y, Nishida T. Deviated mechanism of wound healing in diabetic corneas. Cornea. 2007;26:S75-S81.
  14. Lutty GA. Effects of diabetes on the eye. Invest Ophthalmol Vis Sci. 2013;54:ORSF81-7.
  15. Kaji Y. Prevention of diabetic keratopathy. Br J Ophthalmol. 2005;89:254-5.
  16. Cisarik-Fredenburg P. Discoveries in research on diabetic keratopathy. Optometry. 2001;72:691-704.
  17. Zhivov A, Winter K, Hovakimyan M. Imaging and quantification of subbasal nerve plexus in healthy volunteers and diabetic patients with or without retinopathy. PLoS One. 2013;8:e52157.
  18. Midena E, Brugin E, Ghirlando A, Sommavilla M, Avogaro A. Corneal diabetic neuropathy: a confocal microscopy study. J Refract Surg. 2006;22:S1047-52.
  19. Saito J, Enoki M, Hara M, Morishige N, Chikama T, Nishida T. Correlation of corneal sensation, but not of basal or reex tear secretion, with the stage of diabetic retinopathy. Cornea. 2003;22:15-8.
  20. Akamura M, Kawahara M, Morishige N, Chikama T, Nakata K, Nishida T. Promotion of corneal epithelial wound healing in diabetic rats by the combination of a substance P-derived peptide (FGLM-NH2) and insulin-like growth factor-1. Diabetologia. 2003;46:839-42.
  21. Rocha EM, Cunha DA, Carneiro EM, Boschero AC, Saad MJA, Velloso LA. Identification of insulin in the tear film and insulin receptor and IGF-1 receptor on the human ocular surface. Invest Ophthalmol Vis Sci. 2002;43:963-7.
  22. Wirostko B, Rafii M, Sullivan DA, Morelli J, Ding J. Novel therapy to treat corneal epithelial defects: a hypothesis with growth hormone. Ocul Surf. 2015;13:204-12.e1.
  23. Shanley LJ, McCaig CD, Forrester JV, Zhao M. Insulin, not leptin, promotes in vitro cell migration to heal monolayer wounds in human corneal epithelium. Invest Ophthalmol Vis Sci. 2004;45:1088-94.
  24. Ling K, Bastion M-LC. Use of commercially available sodium hyaluronate 0.18% eye drops for corneal epithelial healing in diabetic patients. Int Ophthalmol. 2019;39:2195-203.
  25. Schulze SD, Sekundo W, Kroll P. Autologous serum for the treatment of corneal epithelial abrasions in diabetic patients undergoing vitrectomy. Am J Ophthalmol. 2006;142:207-11.
  26. Patient information for Humulin R 100IU/ml. Eli Lilly and Company; 2019. (Consultado en septiembre de 2020.) Disponible en: http://pi.lilly.com/us/humulin-r-ppi.pdf
  27. Lansdown AB, Mitrastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: theoretical, experimental and clinical aspects. Wound Repair Regen. 2007;15:2-16.
  28. Tokumitsu A, Kusunoki Y, Torii K. Refractory corneal epithelial diseases due to zinc deficiency: clinical features and treatment in patients with severe motor and intellectual disabilities. Biomedical Research on Trace Elements. 2020;31:1-5.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.