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Kristin Chapman, Ana Alzaga Fernandez, Michelle Lee, Kimberly Sippel, Priyanka Sood, Ryan St Clair, Christopher Starr, Jessica Ciralsky, Mark Rosenblatt; Ocular coherence tomography (OCT) guided adjustment of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) device fit can treat device induced corneal edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3570.
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To evaluate the role of anterior segment OCT (AS-OCT) (Visante, Carl Zeiss Meditec, Dublin, California, USA) in the fitting of PROSE in eyes which developed corneal bullae or microcystic corneal edema following intitaion of device wear.
A retrospective chart review was performed of five eyes of four patients with corneal or ocular surface disorders who were treated with PROSE devices at Weill Cornell Medical College and developed microcystic edema or bullae after beginning device wear. Slit lamp photographs, AS-OCT and clinical charts were used to examine their clinical course. CAD software was used to redesign the haptic angle and central corneal clearance in eyes with central edema, while the haptic angle and diameter were adjusted for patients with peripheral microcystic edema.
The eyes included in this series demonstrated clinical bullae and microcystic edema centrally or peripherally after initiation of PROSE wear which resolved after adjusting the fit with the aid of AS-OCT. The eyes developed bullae and microcystic changes that persisted for an average of 44 days (ranging from 27 to 83 days). For central corneal edema redesign resulted in a change of haptic angle from an avergae of 12.5 degrees before fitting to 14.05 degrees after PROSE change. Redesigned PROSE devices averaged 92.7 ±178.64 microns less vault by AS-OCT as compared to initial fits. The central corneal thickness decreased an average of 57.13 ±73.08 microns as edema and bullae resolved. For patients with peripheral microcystic changes,the distance from the center of the PROSE to the haptic landing zone was on average 4469.83±504.71 microns before and 4960.77±444.90 microns after modification of the fit, resulting in an increase of vault by 150.90±163.58 microns as measured by the AS-OCT. The central corneal thickness decreased a mean of 4.3±47.84 microns as the peripheral corneal edema resolved.
PROSE devices can cause both central and peripheral corneal edema. This case series demonstrates resolution of device induced bullae and microcystic changes after appropriate fit modification with guidance of AS-OCT. Such OCT guided improvement of PROSE fit may allow for better device tolerance and wear times in patients requiring the PROSE.
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