Prosthetic replacement of the ocular surface ecosystem: impact at 5years

Background/aims To determine the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment at 5years. Methods Retrospective review of clinical, manufacturing and quality databases at the Boston Foundation for Sight. Results 121 patients who completed treatment and had 5-year follow-up data were identified from a cohort of patients (n=199) seen in consultation for PROSE treatment from January 2008 to June 2008. Mean age was 52years, M:F=56:65. The primary indication for treatment was ocular surface disease (OSD) in 64 patients and distorted corneal surface in 57 patients. At 5years, continued device wear was confirmed in 89/121 (73.6%) patients. Discontinuation of wear was confirmed in 32/121 (26.4%). There was an increased likelihood of continued device wear at 5years in patients with distorted cornea (84%) compared with those with OSD (64%), (p=0.0121, (2)). National Eye Institute Visual Function Questionnaire (NEI VFQ-25) composite score increased for patients wearing PROSE devices at 6months (=+23 points, mean=82, p<0.001, two-tailed t test) with no significant decline among those still wearing a device at 5years (=-4 points, mean=78, p=0.22, two-tailed t test). At 5years, those wearing (mean=78) had a higher NEI VFQ-25 than those not wearing (mean=70, p=0.029, two-tailed t test). Conclusions PROSE treatment offers continued benefit, as defined by improved visual function and continued device wear at 5years, in patients with complex corneal disease. Patients with distorted cornea have a higher rate of continued wear at 5years than patients with OSD, although this is not true among all subgroups within OSD.