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Nadeem Fatteh, Karen Deloss, Christopher Hood; Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for Visual Rehabilitation in Patients with Corneal Ectasia. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3461. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the utility of the PROSE device for visual rehabilitation in patients with corneal ectasia.
We performed a single-center retrospective chart review of 46 eyes of 28 patients with ectasia fit for the PROSE device between 2010 and 2012. All patients had unsatisfactory vision and had exhausted previous nonsurgical options for visual correction. Topographic indices from the Atlas corneal topographer, change in visual acuity, and achievement of satisfactory fit were recorded.
42 eyes of 26 patients had keratoconus or pellucid marginal degeneration, and 4 eyes of 2 patients had ectasia after LASIK. Mean age was 42.0 ±13.8 years (range 16 - 69), with 8 females (29%) and 20 males (71%). All patients had previously tried rigid gas-permeable lens fitting but could not achieve satisfactory fit or visual acuity. Additionally, 7 patients had tried and failed a piggyback lens, 9 patients a hybrid lens, and 3 patients a commercially available scleral lens. According to the Amsler-Krumeich classification for severity of keratoconus, 1 eye was stage 1, 14 eyes were stage 2, 10 eyes were stage 3 eyes and 21 eyes were stage 4. The steepest simulated keratometry value averaged 52.57 ± 6.26 diopters (D) and the mean difference between steepest and flattest simulated keratometry was 6.25 ± 4.12 D. All eyes were successfully fit with the PROSE device, achieving a comfortable fit with improved subjective visual acuity. Best-corrected acuity improved from 0.438 logMAR (Snellen equivalent 20/55) to 0.062 logMAR (Snellen equivalent 20/23) with the PROSE device (P<0.0001). All eyes achieved a final Snellen visual acuity of 20/40 or better and 35 eyes (76%) achieved 20/25 acuity or better. Patients with stage 4 ectasia had an improvement in best-corrected acuity from 0.711 logMAR (Snellen equivalent 20/103) to 0.065 logMAR (Snellen equivalent 20/23, P<0.0001) with 15 of 21 (71%) achieving 20/25 or better visual acuity.
The PROSE device was successfully fit and improved visual acuity in all eyes with corneal ectasia that had failed previous modalities. PROSE can provide useful visual acuity even in eyes with severe corneal ectasia.
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