Insulina colirio en afecciones de la superficie ocular / Insulin Eye Drops for Eye Surface Conditions

Cuando se produce una erosión corneal y fracasa la epitelización corneal surgen los defectos epiteliales corneales persistentes, cuyo tratamiento es un desafío para el oftalmólogo. Es muy frecuente el fracaso del tratamiento convencional por lo que se mantiene el interés en la búsqueda de otros factores de crecimiento para la cicatrización epitelial tales como los colirios de insulina. La insulina es un péptido estrechamente relacionado con el factor de crecimiento similar a la insulina 1. Su mecanismo de acción no es bien comprendido, sin embargo se acepta que es capaz de inducir migración y proliferación de las células epiteliales corneales, por lo que promueve y acelera la reepitelización de defectos epiteliales persistentes refractarios a tratamiento. La ausencia de una presentación comercial de colirio de insulina, hace necesario conocer su estabilidad físicoquímica y microbiológica así como la eficacia, efectividad y seguridad del colirio de insulina a diferentes concentraciones. De ahí la motivación para realizar una revisión de la literatura existente sobre el empleo del colirio de insulina en el tratamiento del defecto epitelial corneal persistente. Se realizó la búsqueda en bases de datos electrónicas como PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID con el objeto de identificar artículos relacionados con el tema(AU)

When corneal erosion occurs and corneal epithelialization fails, persistent corneal epithelial defects arise, whose treatment is a challenge for the ophthalmologist. The failure of conventional treatment is very frequent; therefore, there is still interest in the search for other growth factors for epithelial healing, such as insulin eye drops. Insulin is a peptide closely related to insulin-like growth factor 1. Its mechanism of action is not well understood; however, it is accepted that it is capable of inducing migration and proliferation of corneal epithelial cells, thereby promoting and accelerating reepithelialization of persistent epithelial defects refractory to treatment. The absence of a commercial presentation for insulin eye drops makes it necessary to know its physicochemical and microbiological stability, as well as the efficacy, effectiveness and safety of insulin eye drops at different concentrations; hence the motivation to review the existing literature on the use of insulin eye drops in the treatment of persistent corneal epithelial defects. The search was carried out in electronic databases such as PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID, with the aim of identifying relevant articles related to the topic(AU)

A study of effectiveness of topical insulin on healing of diabetic ulcers at tertiary health care centre: a cross sectional study from Puducherry

Background: Insulin being a growth factor was proved to stimulate angiogenesis, collagen formation, matrix formation and granulation tissue proliferation in several preclinical studies. The objective was to study effectiveness of topical insulin on healing of diabetic ulcers at tertiary health care centre.Methods: This was a cross sectional study carried out in the Department of surgery of a tertiary health care centre during August 2018 to August 2019 so during this period there were 60 patients. Group A was given topical insulin application. Group B was given saline application. The statistical analysis was done by using SPSS 24.0 version and un-paired t-test and chi-square tests are applied as test of significance.Results: Average time required for granulation tissue to appear (mean±SD) was significantly less in group A as compared to Group B (p<0.001, df=58, t=5.87); Average surface area of wound (mm2) at day 6th day was significantly less in group A (p<0.05, df=58,t=3.98); average depth of the wounds (mm) at day 6th day was significantly less in Group A as compared to in Group B (p<0.001, df=58, t=4.92).Conclusions: The topical application of insulin is significantly associated with fastening of wound healing in the diabetic ulcer.

Efeito da estimulação elétrica de alta voltagem e insulina tópica em lesão cutânea experimental / Resultados de la estimulación eléctrica por alta voltaje e insulina tópica en lesión cutánea experimental / Effect of high-voltage electrical stimulation and topical insulin on experimental cutaneous lesions

RESUMO O objetivo deste estudo foi avaliar o efeito da estimulação elétrica de alta voltagem (EEAV) catódica, associada à insulina tópica, em lesão tegumentar de ratos. Para isso, foram utilizados 42 ratos Wistar (240±30 g), submetidos a retirada cirúrgica de 1 cm2 de pele do dorso em seis grupos (n=7), tratados por sete dias consecutivos: controle (C), estimulação elétrica placebo (EP), estimulação elétrica catódica (EE), insulina tópica (IT), insulina placebo (IP) e EEAV associada a insulina tópica (EE+I). A EEAV foi administrada 24 horas após a cirurgia, 30 minutos por dia, com frequência de 100 Hz e voltagem média de 60 V, mantida no limiar motor. Áreas das lesões foram registradas macroscopicamente no primeiro, quarto e oitavo dia, sendo submetidas a tratamento histológico para inclusão em paraplast® e coloração em hematoxilina e eosina. A epitelização e o perfil numérico das células foram obtidos por análises histométricas. Utilizou-se o teste de Shapiro-Wilk e ANOVA one-way seguida de Bonferrone (p<0,05). Observou-se redução significativa na área da lesão no oitavo dia de tratamento, nos grupos EE e EE+I em relação aos demais grupos. A reepitelização não diferiu entre os grupos, mas a distância entre as bordas da lesão foi menor nos grupos EE e EE+I. Nesses grupos houve aumento significativo (p<0,05) no número de fibroblastos e diminuição de leucócitos. Pode-se concluir que a EEAV catódica acelerou o processo de reparação da lesão, não demonstrando efeito adicional com a aplicação da insulina tópica.

RESUMEN El propósito de este estudio fue evaluar el resultado de la estimulación eléctrica por alta voltaje (EEAV) catódica, asociada a la insulina tópica, en lesión cutánea de ratas. Para ello, se utilizaron 42 ratas Wistar (240±30 g), les sometieron a cirugía de retirada de 1 cm2 de piel del dorso en 6 grupos (n=7), y les trataron por siete días consecutivos: control (C), estimulación eléctrica placebo (EP), estimulación eléctrica catódica (EE), insulina tópica (IT), insulina placebo (IP) y EEAV asociada a la insulina tópica (EE+I). Se aplicó la EEAV 24 horas después de la cirugía, 30 minutos por día, con frecuencia de 100 Hz y voltaje de media tensión de 60 V, y la mantuvo en el umbral motor. Se registraron las áreas de las lesiones macroscópicamente en el primer, cuarto y octavo día, y las sometieron al tratamiento histológico para inclusión en paraplast® y tinción hematoxilina-eosina. Se obtuvo la epitelización y el perfil numérico de las células por análisis histométricos. Se empleó la prueba Shapiro-Wilk y ANOVA one way de Bonferroni (p<0,05). Se redujo significativamente el área de la lesión en el octavo día del tratamiento en los grupos EE y EE+I comparados a los demás grupos. La reepitalización no fue distinta entre los grupos, sin embargo, la distancia entre los bordes de la lesión fue menor en los grupos EE y EE+I. También en estos grupos aumentó significativamente (p<0,05) el número de fibroblastos y disminuyeron los leucocitos. Se concluye que la EEAV catódica aceleró el proceso de reparación de la lesión, pero no ocurrió resultado con la aplicación de la insulina tópica.

ABSTRACT This study aims to evaluate the effect of cathodic high voltage electrical stimulation (HVES), associated with topical insulin, on rat integumentary lesions. For this purpose, 42 Wistar rats (240±30 g) were submitted to surgical removal of 1 cm2 of dorsal skin and divided into six groups (n=7), treated for seven consecutive days: Control (C), placebo electrical stimulation (PES), cathodic electrical stimulation (ES), topical insulin (TI), placebo insulin (PI) and HVES associated with topical insulin (ES+I). HVES was administered 24 hours after surgery, 30 minutes per day, with a frequency of 100 Hz and a mean voltage of 60 V, maintained at the motor threshold. Lesion areas were recorded macroscopically on the first, fourth and eighth day, submitted to histological treatment for inclusion in paraplast® and staining in Hematoxylin and Eosin. Epithelialization and the numerical profile of the cells were obtained by histometric analysis. The Shapiro-Wilk and Anova one-way test was followed by the Bonferroni (p<0.05). There was a significant reduction in the area of the lesion by the eighth day of treatment, both in the ES and ES+I groups, when compared with other groups. Reepithelialization did not differ between groups, but the distance between the edges of the lesion was lower in the ES and ES+I groups. These same groups showed a significant increase (p<0.05) in the number of fibroblasts and a decrease in leukocytes. Thus, we can conclude that cathodic HVES accelerated the lesion repair process, with the topical application of insulin showing no additional effect.