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Jasdeep S Chahal, J Martin Heur, Gloria Chiu; Improvement in Vision and Ocular Function with Prosthetic Replacement of the Ocular Ecosystem (PROSE) Scleral Lens Therapy in Exposure Keratopathy Patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6073.
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Exposure keratopathy, a desiccation of the cornea caused by incomplete lid closure, can be refractory to conventional therapies such as topical lubrication and lid surgery. We used a retrospective interventional case series to test the hypothesis that PROSE therapy, using custom scleral devices, would improve visual acuity and ocular comfort in patients with exposure keratopathy.
This study was approved by the USC IRB. We analyzed charts from September 2009 through June 2014 in a single multi-specialty institutional practice. 29 patients were identified with the diagnosis of exposure keratoconjunctivitis, lagophthalmos, ectropion, or lid retraction or lag, and with a referral to USC Eye Institute after failing conventional therapies. Eighteen of 25 patients deemed PROSE candidates completed the fitting process, and 26 eyes of 18 patients were included in the study. Patients with highly irregular conjunctival surfaces or glaucoma tube shunts were excluded due to the inability to fit them with a PROSE device. The majority of candidates who did not start or complete their treatment were either lost to follow-up or chose not to proceed for financial reasons. Visual acuity and function were assessed before and after PROSE treatment using the Snellen chart and the Ocular Surface Disease Index (OSDI) survey. The OSDI survey is a 12- question, validated measure of dry eye disease. A two-tailed Student’s t-test was used for statistical analysis.
Visual acuity improved from 0.60 ± 0.68 logMAR pre-PROSE to 0.25 ± 0.34 logMAR post-PROSE, p= .0018, n=26 eyes, equivalent to an improvement of 20/79 to 20/36 on the Snellen chart. OSDI scores improved from 56.54 ± 29.75 pre-PROSE to 24.98 ± 21.23 post-PROSE, p= .00043, n=12 patients.
The results of this study support our hypothesis that PROSE therapy is effective in improving visual acuity and ocular comfort in patients with exposure keratopathy.
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