title: Use of Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lenses in Patients with Ocular Chronic Graft-versus-Host Disease.
abstract: The purpose of this study was to evaluate the impact of prosthetic replacement of the ocular surface ecosystem (BostonSight PROSE, Boston Foundation for Sight, Needham, MA) treatment, utilizing customized scleral devices, on visual acuity, visual function, and ocular surface changes in patients with ocular chronic graft-versus-host disease (cGVHD). A retrospective analysis was performed on 79 eyes of 40 patients with cGVHD referred to the University of Southern California department of ophthalmology between November 2009 and July 2013 for PROSE treatment. This analysis included an assessment of ocular symptoms and visual function before and after treatment using the Ocular Surface Disease Index (OSDI) survey. Pre- and post-treatment visual acuity and clinical data were also compared. Twenty-eight male patients and 12 female patients were included in this study. The average age was 56.1 years (range, 27 to 74). Of the 79 eyes treated, 71 (90%) showed improved visual acuity with PROSE treatment. Fifty-seven eyes (72%) experienced a 2- or greater line visual acuity improvement and 14 eyes (18%) experienced a 1-line improvement. Average logarithm of the minimal angle of resolution improved from .49 ± .52 to .16 ± .44 (P < .0001), which correlates to a Snellen score improvement of approximately 20/60 to 20/30. Sixty-six of 79 eyes (84%) showed decreased corneal staining after treatment. All 9 eyes presenting with filamentary keratitis and 3 eyes with epithelial defects demonstrated complete healing of the epithelial surface after PROSE fitting. At post-treatment follow-up, 8 patients had died and 3 stopped wearing their devices. Of the remaining 29 patients, average OSDI scores improved from 72.6 ± 20.1 to 21.1 ± 14.9 (P < .0001). PROSE therapy, utilizing customized scleral lenses, can reduce ocular symptoms, improve visual acuity, and improve ocular surface integrity or appearance in patients with ocular cGVHD.
authors.affiliation: Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California.
authors.forename: Christos
authors.initials: C
authors.lastname: Theophanous
authors.affiliation: Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
authors.forename: John A
authors.initials: JA
authors.lastname: Irvine
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
authors.forename: Pablo
authors.initials: P
authors.lastname: Parker
authors.affiliation: Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California. Electronic address: Gloria.chiu@med.usc.edu.
authors.forename: Gloria B
authors.initials: GB
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004867:Equipment Design; D005123:Eye / Q000276:immunology / Q000473:pathology; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D054120:Phakic Intraocular Lenses; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D007166:Immunosuppressive Agents
keywords: Ocular graft-versus-host disease; Prosthetic replacement of the ocular surface ecosystem; Scleral lens