Comparison of Amniotic Membrane Extract and Insulin Eye Drops for the Management of Persistent Epithelial Defects: A Multicenter Retrospective Study

Purpose: To compare the efficacy and safety of topical insulin and amniotic membrane extract eye drops (AMEED) in promoting healing of corneal persistent epithelial defects (PEDs) refractory to conventional therapy. Patients and Methods: This retrospective comparative study included 27 eyes of 24 patients (mean age 61.0 ± 16.6 years) with PEDs treated with either topical insulin (1 IU/mL) or AMEED four times daily. Clinical outcomes included complete epithelial closure, rate of epithelialization, change in best-corrected visual acuity (BCVA), and occurrence of adverse events. Results: Of 27 eyes, 18 received topical insulin and 9 received AMEED. The mean interval from diagnosis to treatment initiation was 93.4 ± 111.7 days in the AMEED group and 72.5 ± 56.1 days in the insulin group. Complete healing occurred in all eyes (100%) in the insulin group versus 44.4% in the AMEED group. The daily reduction in epithelial defect area during the first two weeks was significantly greater with insulin (P = 0.04). At final follow-up, BCVA improved significantly only in the insulin group (P = 0.006). No adverse reactions were observed in either group; one AMEED-treated eye required amniotic membrane transplantation. Conclusion: Topical insulin and AMEED are both safe and effective for refractory PEDs, but insulin showed superior epithelial healing and visual recovery. Given its availability, low cost, and favorable safety profile, topical insulin may represent a practical alternative in the management of persistent epithelial defects