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BostonSight PROSE – A Great Option for a Complicated Eye Karen L. Lee, O.D., F.A.A.O., F.S.L.S. UCSF Department of Ophthalmology PROSE Treatment Purpose Complex corneal diseases such as herpes zoster keratitis often results in A smaller diameter diagnostic PROSE device with a shallow profile, visually debilitating corneal irregularities. The simultaneous occurrence of notch, and customized haptics was placed on the eye to obtain a proper both irregular corneal contour and other ocular issues, such as glaucoma, over-refraction. Careful attention was paid to central clearance, haptic may be particularly difficult to treat and manage. Traditional treatment alignment and bleb interaction before a custom device was designed for graphic methods for visual improvement include spectacles, soft contact lenses, gas permeable (GP) lenses and corneal surgical procedures. the patient. Through the first customized PROSE device (Figure 3), the patient was Unfortunately, some patients may fail all contact lens modalities and be immediately able to see 20/50 and reported great ocular comfort with poor surgical candidates. A viable solution for these patients is minimal device awareness. The device aligned beautifully with the ocular BostonSight PROSE (prosthetic replacement of the ocular surface surface (Figure 2) and no further improvement in vision was noted with ecosystem) treatment which utilizes custom designed and fabricated over-refraction. The patient successfully completed application and prosthetic devices to improve vision and support impaired ocular surface system functions. Figure 1. Corneal dellen with fluorescein pooling. Figure 2. PROSE device exhibiting central apical clearance, limbal clearance and haptic alignment. A horizontal section approximately 1.25 mm in from the edge was shaved off at the 2:00 position. removal training along with proper device care and handling. The patient was advised to not exceed 8 hours of wear time initially. RM was monitored very carefully for any signs of IOP increase and Case Report corneal edema with device wear. • Three hours after device wear: • VA: 20/50, IOP: 18 mmHg, CCT: 481 um RM, A 83 year old Caucasian male, presented to the clinic for a PROSE • Six hours after device wear: consultation of the right eye. His current ocular status was: • VA: 20/50, IOP: 16 mmHg, CCT: 497 um • One week of device wear (10 hours of device settling): Pertinent Ocular History OD • VA: 20/50, IOP: 14 mmHg, CCT: 490 um • Severe stromal loss secondary to herpes zoster ophthalmicus • One month of device wear: • Band keratopathy S/P EDTA chelation • VA: 20/50, IOP: 11 mmHg, CCT: 487 um • Advanced POAG S/P ALT and Ahmed valve • Three months of device wear: • Wet macular degeneration S/P avastin injections x 5 • VA: 20/50, IOP: 13 mmHg, CCT: 490 um Pertinent Ocular Findings OD • VA cc 20/150 Discussion PHNI • Intraocular pressure (IOP): 14 mmHg • Central corneal thickness (CCT): 479 um • Dellen nasal and temporal to visual axis, tube at 10 o’clock (Figure 1) Patients suffering from complex corneal disease can often benefit from RM had tried and failed the following contact lens (CL) modalities: in the management of concomitant eye disease. BostonSight PROSE the superior optical clarity of GPs. However, traditional CLs may fall short treatment is a great option for any irregular corneal patient that has • Corneal GP failed a scleral lens. Skilled PROSE providers design one-of-a-kind • Reverse geometry GP devices that offer superior comfort and vision. BostonSight PROSE • Intra-limbal GP designs • Scleral contact lens Figure 3. Custom designed eight meridian PROSE device for RM. Note that a horizontal section was shaved off but is not depicted here. treatment restores visual function, supports healing, reduces symptoms and improves quality of life.