Evidence for neurotrophic keratopathy treatments remains limited, review finds
There is no strong, high-certainty evidence supporting any single medical or surgical treatment as a clear standard of care for neurotrophic keratopathy, with most available data showing only low or very low certainty benefits, meaning treatment decisions currently need to be individualized based on clinical judgment and available resources, according to a systematic review.
The review included 7 randomized controlled trials involving 494 participants, with follow-up ranging from 28 days to 18 months. Most studies compared medical therapies with ophthalmic vehicle or artificial tears, while one trial assessed a surgical approach. Interventions studied included topical biologics such as recombinant human nerve growth factor (rhNGF) and recombinant bovine basic fibroblast growth factor, as well as several non-biologic topical agents. One study compared amniotic membrane transplantation with tarsorrhaphy or bandage contact lens use.
Meta-analyses suggested that rhNGF may slightly improve corneal re-epithelialization compared with vehicle or artificial tears, although the certainty of this evidence was low. Results for complete re-epithelialization were similar but showed substantial variability between studies. Other medical treatments generally showed little to no clear benefit for corneal healing, visual acuity, or corneal sensitivity, and the evidence supporting these findings was low or very low in certainty. Limited data also indicated no meaningful differences in adverse event rates between active treatments and controls.
The single surgical trial found that amniotic membrane transplantation may offer little to no benefit over tarsorrhaphy or bandage contact lenses for corneal healing or visual acuity, but the evidence was very uncertain.
Reference
Kruoch Z, Choo AY, Kemp A, et al. Medical and surgical interventions for neurotrophic keratopathy. Cochrane Database Syst Rev. 2025;12(12):CD015723. doi: 10.1002/14651858.CD015723.pub2. PMID: 41347649; PMCID: PMC12679690.
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