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Christos Theophanous, Gloria Chiu, John A Irvine; Improvement in Visual Function and Acuity with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Treatment in Patients with Chronic Graft Versus Host Disease. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5542.
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Chronic Graft versus Host Disease (cGvHD) is a significant complication of hematopoietic stem cell transplantation that can result in ocular discomfort and impaired visual functioning. This study explores the impact of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment, utilizing customized scleral devices, on visual acuity and ocular-related function in cGvHD patients whose symptoms are refractory to conventional therapy.
This is a prospective study of 40 patients with ocular cGvHD who had previously failed conventional therapy and were referred to the USC Department of Ophthalmology between November 2009 and July 2013 for PROSE treatment. Ocular discomfort and visual function were assessed before and after treatment using the standardized Ocular Surface Disease Index (OSDI) survey. Visual acuity changes were also assessed through a retrospective chart review. OSDI and visual acuity changes were analyzed to assess the impact of PROSE wear on ocular symptoms and function.
Of the 40 treated patients (79 eyes), 38 (76 eyes) showed bilateral improved or unchanged visual acuity. On average, logarithm of the minimal angle of resolution (logMAR) visual acuities improved 67.6% from 0.49 ± 0.52 to 0.16 ± 0.44, an equivalent Snellen change of ~20/60 to ~20/30 (Fig. 2). At survey follow-up, 8 patients had expired and 3 stopped wearing their device. Of the remaining 29 “active wear” patients using the device “all,” “most,” or “half” of the time, OSDI scores improved an average of 70.9%, from 72.6 ± 20.1 and 21.1 ± 14.9 (Fig. 1).
PROSE therapy can both reduce ocular symptoms and improve visual acuity in patients with cGvHD and should be considered for patients refractory to conventional therapy. Even patients who did not report better visual acuity benefited from improved ocular comfort.
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