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Janhavi M. Modak, Ashley Kingham, Venus Arevalo, Anisa Gire, Stella K. Kim; Initial Experience of Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) in Cancer Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6552.
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To describe the initial experience of Prosthetic Replacement of Ocular Surface Environment (PROSE) at a tertiary cancer hospital.
IRB approved retrospective chart review was performed in patients from MD Anderson Cancer Center evaluated for PROSE for the management of their ocular surface diseases, between April 1, 2009 and November 1, 2010. Patients’ profiles including their cancer and treatment history, ocular history, pre-post PROSE exams and when available, Ocular Surface Disease Index (OSDI) were reviewed. Literature search was performed for PROSE in cancer population. Student t-test and Mann Whitney tests were used for statistical analysis.
32 patients were included in the study, of which 30 patients were cancer patients and 2 had the diagnosis of mucous membrane pemphigoid. Patients’ cancer diagnoses included leukemia, lymphoma, melanoma, sarcoma and squamous cell carcinoma. All were screened for PROSE fitting, and to date 15 of 32 patients were fitted with PROSE. The median follow up was 4 months, ranging from 1-16 months. The etiology of ocular surface diseases included keratoconjunctivtis sicca from chronic ocular graft vs. host disease, radiation toxicity, and HSV and VZV corneal irregular astigmatism and scarring. The pre PROSE vision ranged from 20/20 to 20/400 with sentinel symptom score of 5 to 10 and the OSDI ranging from 4 to 43 (out of 48 prior to conversion factor). Post PROSE fitting, there was a statistically significant improvement in visual acuity in 75% patients (p=0.039) and in sentinel symptom improvement in 71% patients (p=0.028), with a trend towards a significant decrease in the OSDI scores in 62.5% patients (p=0.059). 2 patients could not tolerate the use of PROSE, and 3 patients experienced worse vision due to on going corneal scarring and retinal toxicities. Two patients deferred treatment due to the associated cost, and 2 were lost to follow up. Previous benefit of PROSE in cancer patient population has not been established.
PROSE appears to be effective in treating ocular surface diseases in cancer patients with improvement in vision and symptom scores. This preliminary limited study of cancer patients with PROSE suggests its usefulness in improving the quality of life in cancer patients. Ocular GVHD patients have been known to benefit from PROSE, but the usefulness of PROSE in cancer patient population in general has not been previously established. A larger prospective study with a longer follow up is needed.
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