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Ryan St Clair, Yvonne Wang, Christopher Starr, Michelle Lee, Ana Alzaga Fernandez, Kimberly Sippel, Jessica Ciralsky, Mark Rosenblatt, Priyanka Sood; Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) Device Wear Results in Decreased Endothelial Cell Density and Decreased Endothelial Pleomorphism. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1682.
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To investigate the effect of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) device on endothelial cell density and morphology.
This was a prospective study, including patients referred for fitting with the PROSE device at Weill Cornell Medical College who achieved more than 6 hours of wear time in at least one eye for at least 30 days. Patients with epithelial defects, baseline endothelial cell counts below 1500 cells per square millimeter, or active intraocular inflammation were excluded. 8 patients (14 eyes) were included in the study. Each patient had confocal microscopy images of the corneal endothelium taken prior to PROSE wear, and at each 2 week follow up visit after wearing the device for longer than 6 hours each day (Confoscan 4, Nidek). Endothelial cell density, polymegatheism, and pleomorphism were calculated using NAVIS software before and after PROSE wear and compared using a two-tailed paired t test. Correlation between percent change in endothelial cell density and days of PROSE wear for longer than 6 hours was assessed using Pearson’s test for linear correlation.
Prior to initiation of PROSE wear mean endothelial cell count was 2499 +/-371 cells/mm2, which significantly decreased to 2336 +/- 365 cells/mm2 following at least 30 days of 6 hours or more of daily PROSE wear (p=0.019). Similarly, this amount of wear caused the percentage of hexagonal endothelial cells to decrease from a baseline of 54.25% +/- 9.09 to 45.97% +/- 7.98 with device wear (p=0.014). There was a significant correlation between days of PROSE wear for more than 6 hours and percent change in endothelial cell density (r=-0.39, p=0.0098). However, an index of polymegatheism was not significantly different before or after PROSE wear (37.05 +/- 9.4 vs. 38.34 +/- 6.59, p=0.41).
Use of the PROSE device is correlated with decreasing endothelial cell density and increased endothelial cell pleomorphism. Increased pleomorphism is considered a marker for endothelial cell stress, and has been associated with contact lens wear. However, decreased endothelial cell density has not been previously reported in connection with use of the PROSE device. Endothelial cell loss or stress may cause corneal edema in PROSE wearers.
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