Abstract
Purpose :
The design of the prosthetic replacement of the ocular surface ecosystem (PROSE) device allows it to serve as a novel drug delivery system. We describe the instillation of amphotericin B and cenegermin in the PROSE device reservoir for the treatment of Candida keratitis in the setting of a persistent epithelial defect (PED).
Methods :
Retrospective case report
Results :
78-year-old female with Sjögren’s syndrome, lack of corneal sensation, and history of corneal melts, infections, perforation, patch graft, and penetrating keratoplasty was dependent on 12-12 regimen of PROSE device wear for support of the ocular surface. She developed a PED. A course of cenegermin was planned when she presented new symptoms of pain and injection. Exam was notable for nodular, white deposits within the PED (Figure 1). Cultures were positive for Candida parapsilosis sensitive to azoles and amphotericin B. She was treated with a two-week course of amphotericin B instilled on the eye and in the PROSE device initially 6x/day then reduced to 4x/day. Eight days later amphotericin B frequency was reduced to 2x/day and cenegermin treatment was instilled on the eye 4x/day and in the PROSE device at the time of 2 of those doses. At no point was device wear ceased nor two drugs instilled simultaneously in the device reservoir. Three weeks after initial diagnosis of Candida keratitis and two weeks after starting cenegermin, her epithelial defect closed (Figure 2). At follow up, 4 weeks after completion of 8-week course of cenergemin, the surface remained intact without recurrence of fungal keratitis.
Conclusions :
Fungal and neurotrophic keratitis typically require cessation of contact lens wear and 6x daily or more administration of therapeutic agents. There have been prior reports of off -label delivery of therapeutic agents in the PROSE reservoir, but none illustrating effectiveness at reduced frequency, nor has delivery of amphotericin B or cenegermin in a PROSE device been previously described. Notably, the short course of amphotericin B and the effectiveness of cenergemin at 4x/day frequency highlight the PROSE device’s capacity to protect the ocular surface and offer effective delivery of medication in patients prone to breakdown.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.