title: Scleral contact lenses in the management of pellucid marginal degeneration.
abstract: OBJECTIVE
  To assess visual improvement with scleral lenses (PROSE, prosthetic replacement of the ocular surface ecosystem, Boston Foundation for Sightight, USA) in patients with Pellucid marginal degeneration (PMD).
  
  
  METHODS
  This is a single-center, retrospective case-series involving patients with clinical PMD who underwent scleral lens-PROSE trial for improvement of visual acuity, from January 2009 to December 2012 at a tertiary center in India. Scleral lenses with different front surface eccentricities (FSE) were tried for improvement of visual acuity. Snellen visual acuity before and with PROSE wear was noted. Complications with PROSE wear to follow-up were noted.
  
  
  RESULTS
  PROSE was dispensed to 12 patients (20 eyes) out of 19 patients having PMD. Location of PMD was inferior in fourteen and superior in two eyes. Four eyes had co-existing keratoconus. Nine were males and three were females. The indications for scleral lens were lens popping-out, failure of piggy-back contact lens and RGP failure. LogMAR Visual acuity improved significantly from 0.45±0.31 pre-PROSE to 0.05±0.08 post-PROSE (p=0.0001). The FSE ordered was 0.6 in 17 eyes, 0.3 in one eye and 0.8 in two eyes. Three patients had hydrops over follow-up; two patients underwent keratoplasty and one was managed conservatively with steroids and hyperosmotic agents. Seven patients did not order PROSE: reasons were - no perceived improvement in visual acuity (n=2), wanted to decide (n=2), continued glasses (n=1) and continued RGP contact lens (n=1). One patient had difficulty with self lens insertion.
  
  
  CONCLUSIONS
  PROSE improves visual acuity in PMD; three patients developed hydrops over follow-up.
authors.affiliation: L V Prasad Eye Institute, Banjara Hills, Hyderabad 500034, Telangana, India. Electronic address: varsharathi@lvpei.org.
authors.forename: Varsha M
authors.initials: VM
authors.lastname: Rathi
authors.affiliation: Bausch & Lomb Contact Lens Centre, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Dumpati
authors.affiliation: Bausch & Lomb Contact Lens Centre, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Preeji S
authors.initials: PS
authors.lastname: Mandathara
authors.affiliation: Cornea Services, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Mukesh M
authors.initials: MM
authors.lastname: Taneja
authors.affiliation: Cornea Services, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000328:Adult; D003261:Contact Lenses / Q000009:adverse effects*; D003316:Corneal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D015715:Corneal Edema / Q000209:etiology* / Q000517:prevention & control; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012590:Sclera; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D014792:Visual Acuity
keywords: Hydrops; PROSE; Pellucid marginal degeneration; Scleral contact lens