Delineating the Therapeutic Potential of Topical Insulin for Ocular Disease Management: A Systematic Review and Meta-Analysis

Abstract

Abstract Background: Ocular surface disorders (OSD) are highly prevalent, affecting millions globally. While conventional treatments offer some level of success, they often fall short in addressing challenging refractory cases. This unmet need has spurred the investigation of novel therapeutic approaches, including the exploration of topical insulin as a potential alternative. Objective: This systematic review and meta-analysis evaluated the safety and efficacy of topical insulin for OSD management. Methods: We conducted a comprehensive search across major databases (PubMed, Scopus, Embase, and Cochrane Library) for studies investigating the use of topical insulin for ocular conditions. Studies were rigorously selected based on pre-defined inclusion/exclusion criteria and assessed for methodological quality using established tools. We extracted and analyzed data pertaining to safety, efficacy, and relevant outcomes for meta-analysis, including healing time. Results: Ten studies (diverse designs: 1 case-control, 3 randomized prospective, 3 retrospective, and 3 double-blind) met the inclusion criteria. These studies explored a range of OSD, including neurotrophic corneal ulcers, persistent epithelial defects, recurrent epithelial erosions, dry eye disease, and postoperative corneal wound healing in diabetic patients. The findings suggest encouraging outcomes for topical insulin across these indications, demonstrating its potential to OSD. A meta-analysis comparing healing times between topical insulin and placebo revealed a statistically significant advantage for the insulin group (Q = 26.81, df = 3, P = 0.000, I² = 96%). Conclusion: This comprehensive review and meta-analysis provide promising evidence for the therapeutic potential of topical insulin in diverse OSD. While methodological limitations exist, particularly in non-randomized studies, the current body of evidence suggests that topical insulin may offer a safe and effective treatment option for patients with refractory OSD.