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.

Mono- and Bi-weekly Hypofractionated Radiation Therapy for the Treatment of Epithelial Skin Cancer in Very Elderly Patients.

BACKGROUND/AIM: Epithelial skin cancer frequently occurs in the elderly population, sometimes in an advanced stage, when intensive treatments are needed. Radiotherapy can achieve high response rates. We evaluated efficacy and tolerability of hypofractionated radiotherapy in a population of very elderly patients with locally advanced epithelial skin cancer. PATIENTS AND METHODS: Two different hypofractionated schedules were administered (21 patients): 6 Gy in 10 bi-weekly fractions (13 lesions) and 5 Gy in 12 bi-weekly fractions (13 lesions). Median age at treatment was 88 years, life expectancy was ≤5 years in 90.5%. RESULTS: The overall response rate was 96.1%, with 92.4% complete responses. All patients experienced an improvement of their symptoms and a reduction of pain and medication. The median overall survival time was 28 months (95% confidence interval=4.7-51.2 months). At the time of analysis, 52.3% of patients had died. CONCLUSION: Hypofractionated radiotherapy is an effective option of treatment, with low toxicity and optimal results, and can also be safely administered to these frail patients.