Topical Insulin for Ocular Surface Disease.

Background: Insulin and insulin-like growth factor (IGF)-1 receptors are present in ocular tissues such as corneal epithelium, keratocytes, and conjunctival cells. Insulin plays a crucial role in the growth, differentiation, and proliferation of corneal epithelial cells, as well as in wound healing processes in various tissues. Purpose: This review explores the potential role of topical insulin in the treatment of ocular surface diseases. Specifically, it examines its impact on corneal nerve regeneration, sub-basal plexus corneal nerves, and its application in conditions like corneal epithelial defects, dry eye disease, and diabetic keratopathy. Methods: The review analyzes studies conducted over the past decade that have investigated the use of topical insulin in ocular surface diseases. It focuses on indications, drug preparation methods, side effects, efficacy outcomes, and variations in insulin concentrations and dosages used. Results: While off-label use of topical insulin has shown promising results in refractory corneal epithelial defects, its efficacy in dry eye disease is yet to be demonstrated. Variations in concentrations, dilutions, and dosing guidelines have been reported. However, limited data on ocular penetration, ocular toxicity, and systemic side effects pose challenges to its widespread utility. Conclusion: This review synthesizes findings from ocular investigations on topical insulin to assess its potential applicability in treating ocular surface and corneal diseases. By highlighting indications, preparation methods, side effects, and efficacy outcomes, it aims to provide insights into the current status and future prospects of using topical insulin in ophthalmic practice.

Undesirable High Astigmatism after Penetrating Keratoplasty in Pseudophakia Corrected with an Add-On Toric Intraocular Lens.

The purpose of the present case is to report the visual outcomes of a pseudophakic patient with high post-penetrating keratoplasty astigmatism treated with implantation of toric AddOn® intraocular lens (IOL) in the sulcus. A 79-year-old man with a ophthalmologic history of pseudoexfoliative glaucoma and Fuchs endothelial dystrophy had a graft failure after Descemet's stripping automated endothelial keratoplasty procedure on his right eye. Consequently, a penetrating keratoplasty was performed, and a high corneal astigmatism of -9.8 D to 140° resulted in that eye after selective suture removal. A secondary AddOn® toric IOL customized for the patient with a manufacturer-calculated power of +11.0 D was implanted to 50° in sulcus of the right eye. Subjective refraction was used for IOL calculation. Final refraction was +1.0 D of sphere and -2.0 D of cylinder power to 105°, with spherical equivalent of 0.0 D. Best corrected visual acuity was logMAR 0.1 (20/25, 0.8 decimal) 1 year after the IOL implant. Our case report demonstrates that the toric AddOn® secondary IOL can be effective and safe in correcting residual refractive error of high regular astigmatism after keratoplasty in pseudophakic eyes.

Cryotherapy after Topical Interferon Alpha 2b to Treat Conjunctival Primary Acquired Melanosis.

When primary acquired melanosis (PAM) with atypia affects the tarsal conjunctiva, a radical surgery can be mutilating, requiring reconstructive surgery of the eyelid. Topical chemotherapy associated to local cryotherapy may be an alternative. A 64-year-old Caucasian female presented with diffuse PAM of the right eye involving the inferior tarsal conjunctiva, fornix, and inferotemporal bulbar conjunctiva. Histological study showed a PAM with atypia (C-MIN 5). Given the extent of the lesion and its location, a wide mutilating excision was ruled out. Topical interferon alpha 2b (IFN-α2b) treatment (1,000,000 IU/mL, 4 times a day) was administered during 10 weeks. However, the regression was very slow. Then local cryotherapy was proposed (8 s at -80°C per application) to the entire pigmented lesion. This afforded progressive depigmentation, which was completed 2 months later. No recurrence of the lesion has been noted during 3 years of follow-up. The combination of the two procedures reduces IFN-α2b eyedrop administration time, enhancing patient compliance. The combination may eradicate the tumor without compromising ocular cosmesis.

Accuracy of 10 IOL power calculation formulas in 100 short eyes (≤ 22 mm).

BACKGROUND: To assess and compare the accuracy of 10 intraocular lens (IOL) power calculation formulas after cataract surgery in eyes with an axial length (AL) shorter than or equal to 22.00 mm. METHODS: A retrospective case series included 100 eyes with an AL ≤ 22.00 mm that underwent uneventful cataract surgery. The refractive prediction error (PE) was calculated using 10 different IOL power calculation formulas: Barrett Universal II, EVO 2.0, Haigis, Hill RBF 2.0, Hoffer Q, Holladay 1 and 2, Kane, SRK/T and SuperLadas. The median absolute prediction error (MedAE ± SD) and mean absolute prediction error (MAE ± SD) were calculated after adjusting the mean prediction error (ME) to 0. RESULTS: Hoffer Q obtained the lowest MedAE (0.292 D) after adjusting the ME to 0, followed very closely by EVO 2.0 (0.298 D) and Kane (0.300 D). EVO 2.0 and Kane obtained both the lowest MAE after adjusting the ME to 0 (0.386). Differences in MAE among the different formulas were not statistically significant (p > 0.05). CONCLUSIONS: Our study reflects a tendency of the EVO 2.0 formula and the Kane formula along with the older Hoffer Q formula, to predict more accurately the refractive outcomes in short eyes that undergo cataract phacoemulsification surgery compared to the other formulas, despite this difference could not be statistically proved.

Adjunctive Treatment with Interferon Alpha 2b in Conjunctival Melanoma.

Purpose: The aim of the study was to demonstrate the clinical outcomes after resection of conjunctival melanoma (CM) followed by topical interferon (IFN) alpha 2b after a long follow-up. Methods: Two consecutive CM patients were treated using tumor excision followed by topical IFN alpha 2b (1,000,000 UI/mL) four times a day for 12 weeks. The second case presented positivity due to the presence of tumor cells in the lower margin of the resection. TNM staging was T1c, N0b, M0, and T1b in the first case and T1b, N0b, M0 in the second case. Follow-up was 72 and 71 months, respectively. Results: No side effects were observable after the administration of topical IFN alpha 2b. After extensive evaluation and imaging with computed tomography, no regrowth or distant metastasis was noticed during the follow-up period in both cases. Conclusions: IFN alpha 2b could be used as a co-adjuvant treatment after CM resection, in an attempt to reduce the possibility of recurrences.

Use of interferon alpha 2b to manage conjunctival primary acquired melanosis and conjunctival melanoma.

Primary acquired melanosis (PAM) is acquired conjunctival pigmentation that can give rise to conjunctival melanoma (CM), a malignant tumor of the bulbar and palpebral conjunctiva or the caruncle. Surgical excision is the treatment of choice for this neoplasm. Topical chemotherapy is also used for patients with PAM with atypia or CM and, in patients with recurrent or extensive disease, this may be an important option. Of the several chemotherapeutic drugs used, topical interferon alpha 2b (IFN-α2b) has become popular because of its low toxicity. Clinical evidence from case reports and case series supports the efficacy of IFN-α2b as the preferred adjuvant treatment for PAM and CM. In addition, topical IFN-α2b has been successfully applied to melanocytic tumors refractory to other treatments, such as cryotherapy and topical mitomycin C. In patients with locally advanced CM, the combination of IFN-α2b and systemic immunotherapy may serve as an alternative to exenteration. Given the low frequency of CM, long-term multicenter studies are needed to demonstrate the efficacy of IFN-α2b for preventing local recurrence and distant metastasis.