Improvement of chronic corneal opacity in ocular surface disease with prosthetic replacement of the ocular surface ecosystem (PROSE) treatment

Abstract

PurposeTo demonstrate clearing of chronic corneal opacities and improvement of visual acuity with the use of BostonSight prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in ocular surface disease.ObservationsWe undertook retrospective analysis of the medical records of a series of patients who underwent PROSE treatment from August 2006 to December 2014. Patients were referred for ocular surface disease of various etiologies. Primary inclusion criterion was corneal opacity that improved with PROSE treatment. Patients were excluded if topical steroids or adjuvant therapy used once PROSE treatment was initiated. Underlying disease, prior treatment, clinical presentation, and clinical course were extracted from the medical record. Four patients are included in this series. There were three females and one male; median age at time of treatment initiation was 30 years (range = 0.5–58 years). Median duration of PROSE treatment at time of retrospective analysis was 3.5 years (range = 1–8 years). Two cases had corneal opacification in the context of neurotrophic keratopathy: a unilateral case due to presumed herpes simplex keratitis and a bilateral case due to congenital corneal anesthesia associated with familial dysautonomia. One case had corneal opacity from exposure related to seventh nerve palsy, and one had corneal opacification associated with recurrent surface breakdown, neurotrophic keratopathy, and limbal stem deficiency of uncertain etiology. After consistent wear of prosthetic devices used in PROSE treatment for support of the ocular surface, visual acuity improved and clearing of the opacities was observed, without use of topical steroids or adjuvant therapy.Conclusions and importanceThese cases demonstrate clearing of chronic corneal opacity with PROSE treatment for ocular surface disease. This clearing can occur with no adjuvant therapy, suggesting that restoration of ocular surface function and integrity allows for corneal remodeling.

Visual and physiological outcomes of scleral lens wear

“…There has been a dramatic increase in the number of scleral publications from 2012 to 2016 compared to the previous 5-year period based on a recent study on the body of scleral lens-related scientific research [1]. Recent literature includes single-center, retrospective case series which generally describe a single lens design and unified fitting philosophy [2][3][4][5][6][7]. Studies on observed or potential impact of scleral lenses on ocular surface structures have also been published within the past 5 years [8,9], as has research on the structure and contour of conjunctival, episcleral, and scleral tissue [10][11][12][13].…”

Scleral contact lenses in the pediatric population—Indications and outcomes

“…Scleral lens use may provide a similar therapeutic effect with better social acceptance. It was previously reported that in cases of neurotrophic keratitis, scleral lenses not only provide protection and facilitate ocular surface healing [19] but may also decrease the degree of chronic corneal opacification [20]. One of the main adverse effects of SL wear is corneal hypoxia and edema [21].…”

In vivo biocompatibility evaluation of in situ-forming polyethylene glycol-collagen hydrogels in corneal defects

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