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Prosthetic Replacement of the Ocular Surface Ecosystem Treatment for Ocular Surface Disease in Pediatric Patients

Yvonne Wang1, Rohini Rao1, Deborah S Jacobs2

  • 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.

American Journal of Ophthalmology
|January 22, 2019
PubMed

Insights

Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment significantly improves vision in pediatric patients with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). This durable vision improvement is achievable in over two-thirds of patients with chronic ocular surface disease.

Area of Science:

  • Ophthalmology
  • Regenerative Medicine

Background:

  • Pediatric chronic ocular surface disease (OSD) often results from Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).
  • Ocular surface damage in SJS/TEN can lead to severe visual impairment.
  • Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) offers a potential therapeutic option.

Purpose of the Study:

  • To evaluate the outcomes of PROSE treatment in pediatric patients diagnosed with SJS/TEN-related chronic OSD.
  • To assess the impact of PROSE on visual acuity and treatment durability in this patient population.

Main Methods:

  • A retrospective, interventional case series design was employed.
  • Data from pediatric patients (≤18 years) with SJS/TEN-related OSD treated with PROSE between 1992 and 2016 were analyzed.
  • Best-corrected visual acuity (BCVA) at presentation, PROSE device dispense, and last follow-up were compared.

Main Results:

  • Twenty-two male and 27 female patients were included, with a mean age of 9.3 years at presentation.
  • Median BCVA improved significantly from 0.6 logMAR (20/80) at presentation to 0.18 logMAR (20/30) at PROSE dispense (P < .0001) and remained stable at the last visit (P = .0004).
  • PROSE treatment was successful in approximately 70% of patients, with 15 patients experiencing treatment failure.

Conclusions:

  • PROSE treatment is a feasible and effective option for managing chronic ocular surface disease in pediatric patients with SJS/TEN.
  • PROSE provides significant and durable improvements in visual acuity for this challenging patient group.
  • Long-term visual rehabilitation is achievable with PROSE in a majority of pediatric SJS/TEN cases.
Abstract

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