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Christopher Thomas Hood, Karen S Deloss, Kyeong Hwan Kim; Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for the Treatment of Limbal Stem Cell Deficiency. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4241.
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© ARVO (1962-2015); The Authors (2016-present)
Limbal stem cell deficiency (LSCD) can have significant ocular morbidity, but current medical and surgical treatments are often inadequate or have significant risks. We hypothesized that the BostonSight Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE), a scleral lens that rests on the conjunctiva, would improve visual function in patients with LSCD. This retrospective, consecutive, interventional case series, therefore, evaluated clinical outcomes of the PROSE device in patients diagnosed with LSCD secondary to a variety of etiologies.
We included 31 eyes of 19 patients from November 2010 to April 2016 who were diagnosed clinically with LSCD and received PROSE treatment. The main outcomes were visual acuity and ocular involvement score, graded using a previously described system for corneal and conjunctival findings. Eight components of ocular involvement were scored from 0 to 3 according to severity.
Mean follow-up after PROSE dispensing was 25.1±18.9 months, with a wearing time of 10.0±4.6 hours per day at final follow up. CDVA improved in 27 eyes (87.1%). Mean corrected distance visual acuity improved from 0.86±0.50 logMAR (Snellen equivalent 20/146) at baseline to 0.46±0.44 (Snellen equivalent 20/58) at last follow-up (P<0.0001). When categorized by disease severity, CDVA improved in less severe eyes (ocular involvement score ≤6) as well as more severe eyes (ocular involvement score ≥7, P=0.00016 and P=0.017, respectively). Mean total ocular involvement score was not significantly different before and after PROSE wear (P=0.645), however mean epithelial defect score was significantly less at last follow-up (P=0.034). For all other components of the ocular involvement score there were no significant differences from baseline to final follow-up.
PROSE improved visual acuity in patients with LSCD without an overall change in ocular involvement score, suggesting that the ocular surface may be stabilized with device wear.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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