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Kristen M. Hawthorne, Hong-Gam Le, Deborah S. Jacobs; Prosthetic Replacement of the Ocular Surface Ecosystem for Ocular Surface Disease. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6553.
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To report the success rate of prosthetic replacement of the ocular surface ecosystem (PROSE) in the treatment of patients with ocular surface disease. Treatment is indicated for improvement in vision, improvement in symptoms, or support of the ocular surface.
Retrospective medical record review of 92 patients with ocular surface disease referred for PROSE treatment 1/1/08 - 6/30/08 was conducted. Candidacy for treatment, completion of fitting process, and change in visual acuity are reported. Device wear status and change in visual function as measured by the NEI VFQ-25 at six months are reported.
In this cohort of 92 patients, 2 did not proceed beyond consultation for medical and anatomical reasons. Of the remaining 90 patients, 7 did not proceed to fitting due to limited improvement from baseline or inability to cooperate for fitting. Of the 83 candidates for PROSE treatment, 13 were not dispensed devices because of inadequate relief of symptoms (3), training failure (4), epithelial edema with lens wear (1) and failure to return for, or compete fitting (5). Of the 70 patients (128 eyes) dispensed devices, mean visual acuity with habitual correction improved from logMAR -0.466 (20/60) to logMAR -0.181 (20/30) in the PROSE device (p = 2.8 x 10-15). 44 of 70 (63%) patients dispensed devices were wearing a device at six month VFQ follow up, with change in mean VFQ from 53 to 79 points (p = 4.5 x 10-12). Likelihood of successful wear of PROSE device may be predicted based on clinical diagnosis. (See Figure 1)
PROSE offers significant improvement in visual acuity and visual function in a majority of patients with ocular surface disease. Patients most likely to benefit from PROSE treatment are those with Stevens Johnson syndrome, chronic graft vs. host disease, limbal stem cell deficiency, primary Sjogrens syndrome, secondary Sjogrens syndrome and exposure keratopathy. Patients with other diagnoses are less successful candidates and may require adjunctive therapy beyond PROSE treatment.
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