Two-year follow-up shows effectiveness of topical insulin for neurotrophic keratopathy

Topical insulin, combined with preservative-free lubricants and prophylactic antibiotics, may be an effective long-term treatment for neurotrophic keratopathy in patients with congenital insensitivity to pain with anhidrosis (CIPA), according to a study.

A recent case highlighted the successful use of topical insulin in managing neurotrophic keratopathy in a patient with CIPA. The 3-year-old boy initially presented with a corneal perforation in his right eye, requiring tectonic amniotic membrane transplantation. Examination revealed a central corneal ulcer with stromal infiltration in the left eye and complete corneal anesthesia in both eyes.

Given his systemic CIPA features—including anhidrosis, lack of pain response, and self-injurious behavior—treatment with topical insulin, preservative-free lubricants, and prophylactic antibiotics was initiated. Within 2 weeks, the left corneal ulcer had healed, and long-term therapy was maintained.

After a 2-year follow-up, the left cornea remained stable with a small paracentral nebula, while the right cornea had a central non-adherent leucoma. No recurrence of corneal ulceration was observed.

Reference
Eleiwa T, Farid MF, Elhusseiny AM. Topical insulin in pediatric neurotrophic keratopathy associated with CIPA syndrome. J AAPOS. 2025;104120. doi: 10.1016/j.jaapos.2025.104120. Epub ahead of print. PMID: 39921158.