New pharmacological and biotechnological approaches for the treatment of neurotrophic keratopathy: From growth factors to gene therapy

Neurotrophic keratopathy (NK) is a serious ocular surface disease that develops due to a reduction or loss of corneal innervation. Conventional therapeutic approaches, such as the use of artificial tears and autologous serum, primarily serve as symptomatic relief measures and do not target the underlying neurodegenerative process. The introduction of recombinant human nerve growth factor (rhNGF, cenegermin) has marked the first disease-modifying pharmacological therapy for NK, providing evidence of enhanced epithelial healing and improved corneal sensitivity. In recent years, with biotechnological advancements and the emergence of genetic therapy strategies, the importance of pathophysiology-oriented treatments in NK therapy has increased. The objective of this review is to offer an analysis of the management of NK in the context of recent pharmacological and biotechnological advancements in the light of current literature. This review aims to provide an integrated and pathophysiology-oriented synthesis of NK management, uniquely bridging pharmacological treatments with emerging biotechnological strategies including gene therapy, cell-based approaches, and novel drug delivery systems.