Neurotrophic keratopathy: Pros and cons of current treatments

Background: Several therapeutics have been proposed for neurotrophic keratitis, but no direct comparison among different approaches is available. Objective: To compare treatment-related problems and outcomes of both traditional and novel therapeutics for neurotrophic keratopathy, focusing on resolution rate, healing time, and recurrence rate. Data sources: Literature search of published studies between 1980 and 2019 on neurotrophic keratopathy available on PubMed was made without any language constraints but limited to human study participants. Study selection: All published peer-reviewed open, blinded and randomized clinical trials, case series and case reports, divided according to evidence level, were reviewed and resolution rate, healing time, relapses of the disease, and visual outcomes were evaluated. Data extraction and synthesis: Single observer data extraction. Main outcomes and measures: resolution rate, healing time, recurrence rate. Results: Human recombinant Nerve Growth Factor eye drops, Serum Tears and Substance P showed comparable resolution rate in patients with neurotrophic keratopathy. Amniotic membrane transplantation and Nerve Growth Factor eye drops are associated with a faster healing time among available treatments. Nerve Growth Factor eye drops clinical trial are the only study with evidence level 1, hence randomized and controlled. Conclusions and relevance: Several new treatment options are available for patients with neurotrophic keratitis with adequate safety.