title: PROSE Treatment in Atypical Ocular Graft-Versus-Host Disease.
abstract: To report a case of persistent epithelial defects in a patient with ocular chronic graft-versus-host disease that required coordinated modulation of systemic immunosuppressive treatment and overnight wear of Prosthetic Replacement of the Ocular Surface Ecosystem (BostonSight PROSE, Needham, MA) devices to achieve ocular surface healing.
  
  
  
  The case of a 38-year-old male patient who presented with a 2-year history of ocular chronic graft-versus-host disease, ocular burning, pain, light sensitivity, and a 3-week history of bilateral corneal epithelial defects is presented. Standard therapies and an initial PROSE treatment utilizing customized scleral lenses were unsuccessful in resolving his ocular complications. A second trial of PROSE treatment involving overnight wear of the devices in combination with increased systemic immunosuppressant therapy ultimately allowed ocular surface healing and improved his discomfort, vision, and quality of life.
  
  
  
  Sight-threatening complications of ocular chronic graft-versus-host disease often require a multidisciplinary approach. Persistent corneal epithelial defects may require increased systemic immunosuppression and extension of PROSE treatment to overnight wear.
authors.affiliation: *OD †BA ‡MD Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California (GBC, CT); and Doheny Eye Institute, University of California Los Angeles, Los Angeles, California (JAI).
authors.forename: Gloria B
authors.initials: GB
authors.lastname: Chiu
authors.forename: Christos
authors.initials: C
authors.lastname: Theophanous
authors.forename: John A
authors.initials: JA
authors.lastname: Irvine
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003261:Contact Lenses / Q000706:statistics & numerical data*; D003316:Corneal Diseases / Q000503:physiopathology / Q000628:therapy*; D019573:Epithelium, Corneal / Q000473:pathology*; D058447:Eye Pain; D006086:Graft vs Host Disease / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing / Q000502:physiology
chemical_list: D007166:Immunosuppressive Agents