Download Purpose PROSE Treatment Case Report Discussion

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.