PROSE Therapy Used to Minimize Corneal Trauma in Patients With Corneal Epithelial Defects

• Published in: American journal of ophthalmology 2013-04, Vol.155 (4), p.615-619.e2
• Main Authors: Ling, Jeanie D, Gire, Anisa, Pflugfelder, Stephen C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Contact Lenses; Corneal Diseases - etiology; Corneal Diseases - physiopathology; Corneal Diseases - therapy; Defects; Epithelium, Corneal - pathology; Female; Humans; Hydrogels; Injuries; Male; Middle Aged; Ophthalmology; Patients; Prostheses; Prostheses and Implants; Prosthesis Implantation; Recurrence; Retrospective Studies; Transplants & implants; Treatment Outcome; Visual Acuity - physiology; Wound healing; Wound Healing - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2012.09.033

Purpose To review the effectiveness of continuous or extended daily wear of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for treating recurrent or persistent corneal epithelial defects from a variety of causes that were refractory to conventional therapy in 9 patients. Design Retrospective case series. Methods The medical records of 9 patients with a history of recurrent or persistent corneal epithelial defects resistant to conventional medical treatment who received treatment at the Cullen Eye Institute between January 2011 and July 2012 were reviewed. Demographic information, etiology, prior treatment, and outcome of PROSE treatment were analyzed. Recurrence after cessation of PROSE and complications were also identified. Results The etiologies of recurrent or persistent corneal epithelial defects in this series included neurotrophic keratopathy, lattice and Avellino dystrophy, Stevens-Johnson syndrome, and chemical/thermal injury. All patients were initially treated with bandage contact lens; however, continuous silicone hydrogel lens wear was not effective in preventing recurrence or healing corneal epithelial defects in all patients. Epithelial defects healed without recurrence in all 9 patients treated with PROSE. Eight patients developed recurrent epithelial defects when PROSE was discontinued, but rehealed after resuming PROSE. Visual acuity improved in 8 patients (88.9%) treated with PROSE. Conclusions Complex persistent or recurrent corneal epithelial defects that failed to heal with extended silicone hydrogel contact lenses healed with PROSE. PROSE therapy was well tolerated, but corneal epithelial defects recurred in all but 1 case following cessation of therapy.