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P. Lim, D. S. Jacobs, P. Rosenthal; Treatment of Persistent Corneal Epithelial Defects With the Boston Ocular Surface Prosthesis and an Antibiotic Adjunct. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6350.
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To report the use of the Boston Ocular Surface Prosthesis (BOSP) with an antibiotic adjunct in the treatment of persistent corneal epithelial defect (PCED).
A clinical database of patients fitted with the BOSP, a fluid-ventilated gas-permeable scleral lens, at the Boston Foundation for Sight from March 2003 to August 2008 was searched to identify patients with the diagnosis of PCED. Beginning with its introduction as the only commercially available non-preserved topical antibiotic drop in March 2003, ophthalmic moxifloxacin was added to the lens reservoir at daily cleaning and insertion in all cases in which extended (overnight) wear was indicated. Chart review was performed. Patient diagnoses, previous treatment, days to re-epithelialization, concurrent topical medications, and complications were recorded. These were compared to historical data from this institution for patients with PCED who did not use an antibiotic adjunct in the lens reservoir during extended wear of the BOSP.
Twenty eyes from nineteen patients were identified for this study. Diagnoses included graft-versus-host disease (7/20), neurotrophic cornea (5/20), limbal stem cell deficiency (4/20), Stevens-Johnson syndrome (2/20), keratoconjunctivitis sicca (1/20), and ectrodactyly-ectodermal dysplasia-cleft palate (EEC) syndrome (1/20). Extended wear with moxifloxacin was utilized for a total of 372 days under our supervision, with a median of 8.5 days (range = 2 to 76 days). Re-epithelialization of the initial PCED treated with EW occurred in 16 eyes. Within this group of 16 eyes, healing occurred in ≤7 days in 12 eyes, ≤14 days in 2 eyes, and >14 days in 2 eyes (range = 1 to 35 days). Four eyes did not re-epithelialize during our follow-up period. There were no cases of microbial keratitis associated with extended wear of the BOSP.
The BOSP is effective in promoting healing of persistent corneal epithelial defects refractory to other measures. Although microbial keratitis associated with extended wear of the BOSP was reported by this institution in 4/14 eyes prior to the advent of non-preserved 4th-generation fluoroquinolones, we found 0 cases of infection in 20 eyes after the introduction of this antimicrobial adjunct, suggesting a substantial reduction of risk.
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