Asghari Bita, Carrasquillo Karen G, Kwok Alan, Sippel Kimberly C
BostonSight, 464 Hillside Ave., Unit 205, Needham, MA, 02494, USA.
Weill Cornell Medicine, 1305 York Ave., 12th Floor, New York, NY, 10021, USA.
Am J Ophthalmol Case Rep. 2023 Sep 1;32:101919. doi: 10.1016/j.ajoc.2023.101919. eCollection 2023 Dec.
To describe the long-term outcome of the use of a specialized scleral lens known as a prosthetic replacement of the ocular surface ecosystem (PROSE) device to support the ocular surface in patients with a Boston Keratoprosthesis (KPro) Type I. All patients in this series were unable to pursue continuous wear of a bandage soft contact lens (BSCL) - a critical aspect of post KPro implantation management intended to protect the corneal carrier tissue from desiccation and stromal melting.
Four eyes of four patients with a Boston KPro Type I were included. All four had failed BSCL wear and were instead treated with PROSE device wear. All four patients had underlying diagnoses associated with a diseased ocular surface (Stevens-Johnson Syndrome [one patient], prior failed penetrating keratoplasty associated with herpes zoster-related neurotrophic keratopathy [one patient], and prior failed penetrating keratoplasty associated with severe dry eye disease [two patients]). Causes of failure of BSCL wear included poor retention, discomfort, and poor vision. PROSE device wear was initiated on average seven and a half (range four to 14) months post-KPro implantation. The wear schedule varied and ranged from waking-hour wear only to 24-h wear. The average duration of device wear was 59.3 (range 28-103) months. Two patients exhibited persistent corneal epithelial defect formation with waking-hour wear, which resolved within 10 days with 24-h device wear. All patients exhibited improvement in vision with PROSE compared to baseline, averaging six and a half (range six to eight) lines of improvement in Snellen acuity, and all patients reported increased comfort. There was no incidence of microbial keratitis, KPro device instability, or other complication throughout the duration of device wear.
This report offers a novel alternate approach to long-term support of the ocular surface in patients with a Boston KPro who fail standard continuous BSCL wear.
描述使用一种名为眼表生态系统假体置换（PROSE）装置的特殊巩膜镜来支持I型波士顿人工角膜（KPro）患者眼表的长期效果。本系列中的所有患者都无法持续佩戴绷带软性角膜接触镜（BSCL），而持续佩戴BSCL是KPro植入术后管理的一个关键方面，旨在保护角膜载体组织免于干燥和基质溶解。
纳入了4例I型波士顿KPro患者的4只眼。这4例患者均无法成功佩戴BSCL，转而接受PROSE装置佩戴治疗。所有4例患者都有与患病眼表相关的基础诊断（史蒂文斯-约翰逊综合征[1例患者]、先前穿透性角膜移植失败伴带状疱疹相关神经营养性角膜病变[1例患者]、先前穿透性角膜移植失败伴严重干眼疾病[2例患者]）。BSCL佩戴失败的原因包括固位不佳、不适和视力差。PROSE装置佩戴平均在KPro植入后7个半月（范围4至14个月）开始。佩戴时间安排各不相同，从仅在清醒时佩戴到24小时佩戴。装置佩戴的平均持续时间为59.3个月（范围28至103个月）。2例患者在清醒时佩戴时出现持续性角膜上皮缺损形成，在24小时佩戴装置后10天内缺损消失。与基线相比，所有患者佩戴PROSE后视力均有改善，Snellen视力平均提高6.5行（范围6至8行），所有患者均报告舒适度增加。在装置佩戴期间未发生微生物性角膜炎、KPro装置不稳定或其他并发症。
本报告为标准持续BSCL佩戴失败的波士顿KPro患者的眼表长期支持提供了一种新的替代方法。
