Sébastien Roumeau1, Frédéric Dutheil2, Vincent Sapin3,4, Julien S Baker5, Stephanie L Watson6,7, Bruno Pereira8, Frédéric Chiambaretta1,4, Valentin Navel9,10. 1. CHU Clermont-Ferrand, Ophthalmology, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France. 2. Preventive and Occupational Medicine, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Université Clermont Auvergne, Witty Fit, 63000, Clermont-Ferrand, France. 3. CHU Clermont-Ferrand, Biochemistry and Molecular Genetics, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France. 4. CNRS UMR 6293, INSERM U1103, Genetic Reproduction and Development Laboratory (GReD), Translational Approach To Epithelial Injury and Repair Team, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. 5. Center for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong. 6. Faculty of Medicine and Health, Save Sight Institute, Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia. 7. Sydney Eye Hospital, Sydney, NSW, Australia. 8. CHU Clermont-Ferrand, Clinical Research and Innovation Direction, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France. 9. CHU Clermont-Ferrand, Ophthalmology, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France. valentin.navel@hotmail.fr. 10. CNRS UMR 6293, INSERM U1103, Genetic Reproduction and Development Laboratory (GReD), Translational Approach To Epithelial Injury and Repair Team, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. valentin.navel@hotmail.fr.
Abstract
PURPOSE: Management of NK can be difficult, involving a range of treatments with variable efficacy. We conducted a systematic review and meta-analysis to evaluate the efficacy of medical and surgical treatments for neurotrophic keratitis (NK). METHOD: PubMed, Cochrane Library, Embase, ClinicalTrial.gov, and ScienceDirect were searched for studies assessing efficacy of NK treatments. We computed random-effect meta-analyses on corneal healing, time to complete healing, and visual acuity changes between baselines and after treatment, stratified on treatment classes. We followed the PRISMA guidelines (registration number CRD42021225721). RESULTS: We included 20 studies: 571 patients and 5 treatment classes (2 surgical and 3 non-surgical). The percentage of patients with complete corneal healing did not differ between specific treatments (nerve growth factor eyedrops (NGF), 75%, 95CI 46 to 104%; autologous serum (AS), 92%, 86 to 98%; neurotization, 99%, 95 to 103%; amniotic membrane transplantation (AMT), 86%, 78 to 94%). All specific treatments had better percentage of complete healing (p < 0.001) than non-specific treatment groups, i.e., mainly lubricants (23%, 14 to 32). Time to complete healing was 24.2 days (5.4 to 43.1) with NGF, 27.6 days (15.2 to 40.0) with AS, 117 days (28.8 to 205.2) with neurotization, and 16.4 days (11.1 to 21.7) with AMT. Only NGF and AMT improved visual acuity. Efficacy outcomes were not affected by sociodemographic (age, sex) nor severity of disease (Mackie stages). CONCLUSION: We confirmed the efficacy of specific treatments in NK. Further comparative trials are needed to investigate the medical and economic benefits of innovative therapies.
PURPOSE: Management of NK can be difficult, involving a range of treatments with variable efficacy. We conducted a systematic review and meta-analysis to evaluate the efficacy of medical and surgical treatments for neurotrophic keratitis (NK). METHOD: PubMed, Cochrane Library, Embase, ClinicalTrial.gov, and ScienceDirect were searched for studies assessing efficacy of NK treatments. We computed random-effect meta-analyses on corneal healing, time to complete healing, and visual acuity changes between baselines and after treatment, stratified on treatment classes. We followed the PRISMA guidelines (registration number CRD42021225721). RESULTS: We included 20 studies: 571 patients and 5 treatment classes (2 surgical and 3 non-surgical). The percentage of patients with complete corneal healing did not differ between specific treatments (nerve growth factor eyedrops (NGF), 75%, 95CI 46 to 104%; autologous serum (AS), 92%, 86 to 98%; neurotization, 99%, 95 to 103%; amniotic membrane transplantation (AMT), 86%, 78 to 94%). All specific treatments had better percentage of complete healing (p < 0.001) than non-specific treatment groups, i.e., mainly lubricants (23%, 14 to 32). Time to complete healing was 24.2 days (5.4 to 43.1) with NGF, 27.6 days (15.2 to 40.0) with AS, 117 days (28.8 to 205.2) with neurotization, and 16.4 days (11.1 to 21.7) with AMT. Only NGF and AMT improved visual acuity. Efficacy outcomes were not affected by sociodemographic (age, sex) nor severity of disease (Mackie stages). CONCLUSION: We confirmed the efficacy of specific treatments in NK. Further comparative trials are needed to investigate the medical and economic benefits of innovative therapies.
Authors: Tanya Trinh; Gisella Santaella; Michael Mimouni; Zale Mednick; Eyal Cohen; Nir Sorkin; David S Rootman; Allan R Slomovic; Clara C Chan Journal: Ocul Surf Date: 2020-11-12 Impact factor: 5.033
Authors: Harminder S Dua; Dalia G Said; Elisabeth M Messmer; Maurizio Rolando; Jose M Benitez-Del-Castillo; Parwez N Hossain; Alex J Shortt; Gerd Geerling; Mario Nubile; Francisco C Figueiredo; Saaeha Rauz; Leonardo Mastropasqua; Paolo Rama; Christophe Baudouin Journal: Prog Retin Eye Res Date: 2018-04-23 Impact factor: 21.198
Authors: Antonio Di Zazzo; Marco Coassin; Giuseppe Varacalli; Emanuela Galvagno; Antonio De Vincentis; Stefano Bonini Journal: Ocul Surf Date: 2019-09-14 Impact factor: 5.033