Abstract
Purpose :
Previously, mini-scleral lenses have been shown to improve exposure keratopathy in thyroid eye disease (TED) patients. The use of the prosthetic replacement of the ocular surface ecosystem (PROSE, BostonSightTM, Boston, MA, USA) for TED has been less well described. The purpose of this study was to determine if visual acuity (VA) improves with PROSE wear in TED patients who develop recurrent proptosis with exposure keratopathy after orbital decompression surgery.
Methods :
This was a retrospective interventional case series including 3 patients (4 eyes) treated between December 2014 and November 2018 within the PROSE treatment program at Weill Cornell Medical College. Patients were included if they had a diagnosis of TED and had recurrent proptosis after orbital decompression. Patients were excluded if they had worn other scleral lenses prior to PROSE treatment or were too young to participate in Snellen VA measurements. Primary outcome was corrected VA measured prior to PROSE use, at the initial PROSE fitting, and at 3, 6, and 12 months after PROSE wear.
Results :
Average age was 67 (±12) and all patients were female. All 3 patients (4 eyes) had undergone prior orbital decompression surgery. Additionally, 2 patients (3 eyes) had undergone upper and/or lower eyelid retraction repair, and 1 patient (1 eye) had undergone upper eyelid gold weight implantation. The mean number of failed treatments for exposure keratopathy prior to PROSE referral was 6.8±1, including both conservative and surgical therapies. Average pre-PROSE corrected VA converted to logMAR was 0.60±0.60 logMAR. At initial PROSE fitting, average corrected VA improved to 0.23±0.21 logMAR. Average VAs at different time points of PROSE use were as follows: 0.27±0.24 logMAR at 3-months, 0.21±0.33 logMAR at 6-months, and 0.05±0.03 logMAR at 12-months. Mean best-corrected visual acuity (BCVA) achieved was 0.14±0.27 logMAR, which occurred at an average of 75±31 days. After PROSE wear, all patients reported improved vision and comfort, and were found to have partial or complete resolution of SPK, corneal haze, and/or neovascularization on exam.
Conclusions :
PROSE was found to improve VA, comfort, and ocular surface quality in TED patients with recurrent proptosis after orbital decompression. VA improved from a baseline of 20/80 to a BCVA of 20/25 by an average of 2.5 months of PROSE wear.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.