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Billy Xiaoyi Pan, Gloria B. Chiu, Martin Heur; Prosthetic Replacement of the Ocular Surface Ecosystem Therapy for Sjogren’s Syndrome Patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3890. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Sjogren’s syndrome is an autoimmune disease that predominantly affects the salivary and lacrimal glands. Immune-mediated destruction of the lacrimal gland produces keratoconjunctivitis sicca that can be difficult to manage with conventional dry eye therapies. Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) therapy utilizes a custom-designed scleral device that vaults the entire cornea and limbus, bathing the ocular surface in preservative-free sterile saline. PROSE therapy has been shown to be beneficial in numerous other ocular surface diseases. The objective of this study was to evaluate the utility of PROSE therapy for patients with Sjogren’s related dry eye disease with outcomes based on visual acuity and function.
The University of Southern California Institutional Review Board approved this study. A retrospective review from July 2009 to October 2015 of patients referred to USC Eye Institute for PROSE therapy consultation identified 37 patients with Sjogren’s syndrome related dry eye disease. Eight patients were excluded because they did not complete the fitting process for reasons such as being lost to follow-up, inability to obtain insurance authorization, difficulty with insertion and removal of the lens, or desire to continue with topical therapy. One additional patient was excluded because he was previously fit with PROSE at another institution. Of the 28 remaining patients, visual acuity, before and after PROSE fitting, was assessed using a Snellen chart under standardized conditions. Visual function was assessed before and after PROSE fitting using the Ocular Surface Disease Index (OSDI) questionnaire. Wilcoxon signed-rank test was used to evaluate changes in visual acuity and OSDI scores.
Fifty-six eyes from 27 female patients and 1 male patient were included in this initial study. The average age was 52.3 years with a range of 30 to 65 years. The average visual acuity improved from 0.18 ± 0.20 logMAR (approximately 20/30) pre-PROSE to 0.08 ± 0.15 logMAR (approximately 20/25) post-PROSE (Z = -4.42; p < 0.01). Nine patients completed both the pre- and post-PROSE OSDI questionnaire. The average OSDI score improved from 66.9 ± 23.1 pre-PROSE to 31.4 ± 12.6 post-PROSE (Z = -3.24; p < 0.01).
The data suggest that PROSE therapy is an effective treatment for patients suffering from Sjogren’s related dry eye disease
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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