Leong CY, Naffi AA, Wan Abdul Halim WH, Bastion MLC. Usage of topical insulin for the treatment of diabetic keratopathy, including corneal epithelial defects. World J Diabetes 2023; 14(6): 930-938 [PMID: 37383598 DOI: 10.4239/wjd.v14.i6.930]
Corresponding Author of This Article
Mae-Lynn Catherine Bastion, DO, FRCS, MBBS, Full Professor, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine Universiti Kebangsaan Malaysia Jalan Yaacob Latif, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia. maelynnb2003@yahoo.com
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Jun 15, 2023; 14(6): 930-938 Published online Jun 15, 2023. doi: 10.4239/wjd.v14.i6.930
Usage of topical insulin for the treatment of diabetic keratopathy, including corneal epithelial defects
Ching Yee Leong, Ainal Adlin Naffi, Wan Haslina Wan Abdul Halim, Mae-Lynn Catherine Bastion
Ching Yee Leong, Ainal Adlin Naffi, Wan Haslina Wan Abdul Halim, Mae-Lynn Catherine Bastion, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
Author contributions: Leong CY, Naffi AA, Bastion MLC and Wan Abdul Hamid WH designed the research study; all authors performed the research and screened for relevant articles; Leong CY and Naffi AA analyzed the data and wrote the manuscript; Bastion MLC revised the manuscript and formatted the article; Wan Abdul Hamid WH evaluated the writing and made further amendments to it.
Conflict-of-interest statement: Bastion MLC received fees for serving as a speaker and/or an advisory board member for Novartis, Alcon, and Santen. She received fees for serving as a speaker for Bayer, Lumibird, and Allergan. She has received research funding from Alcon, Novartis, Santen, TRB Chemedica, IDB healthcare, and National University of Malaysia. She is an employee of the National University of Malaysia. Wan Abdul Halim WH received travel funding from Santen. She is also a key opinion leader for Oculus GMBH. She is an employee of Universiti Kebangsaan Malaysia. Leong CY and Naffi AA have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mae-Lynn Catherine Bastion, DO, FRCS, MBBS, Full Professor, Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine Universiti Kebangsaan Malaysia Jalan Yaacob Latif, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia. maelynnb2003@yahoo.com
Received: December 27, 2022 Peer-review started: December 27, 2022 First decision: February 8, 2023 Revised: March 14, 2023 Accepted: April 24, 2023 Article in press: April 24, 2023 Published online: June 15, 2023 Processing time: 169 Days and 16.5 Hours
Abstract
BACKGROUND
Diabetic keratopathy (DK) occurs in 46%-64% of patients with diabetes and requires serious attention. In patients with diabetes, the healing of corneal epithelial defects or ulcers takes longer than in patients without diabetes. Insulin is an effective factor in wound healing. The ability of systemic insulin to rapidly heal burn wounds has been reported for nearly a century, but only a few studies have been performed on the effects of topical insulin (TI) on the eye. Treatment with TI is effective in treating DK.
AIM
To review clinical and experimental animal studies providing evidence for the efficacy of TI to heal corneal wounds.
METHODS
National and international databases, including PubMed and Scopus, were searched using relevant keywords, and additional manual searches were conducted to assess the effectiveness of TI application on corneal wound healing. Journal articles published from January 1, 2000 to December 1, 2022 were examined. The relevancy of the identified citations was checked against predetermined eligibility standards, and relevant articles were extracted and reviewed.
RESULTS
A total of eight articles were found relevant to be discussed in this review, including four animal studies and four clinical studies. According to the studies conducted, TI is effective for corneal re-epithelialization in patients with diabetes based on corneal wound size and healing rate.
CONCLUSION
Available animal and clinical studies have shown that TI promotes corneal wound healing by several mechanisms. The use of TI was not associated with adverse effects in any of the published cases. Further studies are needed to enhance our knowledge and understanding of TI in the healing of DK.
Core Tip: Diabetic keratopathy (DK) is a common complication of diabetes mellitus that is responsible for poor corneal wound healing. It also reduces quality of vision and quality of life. DK is the result of damage resulting from insulin deficiency, hyperglycemia and neuropathy. Topical insulin has been described as an effective and safe new treatment for DK that can normalize the ocular surface and healing rate of epithelial defects. This review examines the available evidence.
