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Br J Ophthalmol. 2016 Sep;100(9):1171-5. doi: 10.1136/bjophthalmol-2015-307483. Epub 2015 Dec 7.

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

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Boston Foundation for Sight, Needham, Massachusetts, USA Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Boston Foundation for Sight, Needham, Massachusetts, USA.



To determine the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment at 5 years.


Retrospective review of clinical, manufacturing and quality databases at the Boston Foundation for Sight.


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 52 years, 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 5 years, 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 5 years in patients with distorted cornea (84%) compared with those with OSD (64%), (p=0.0121, χ(2)). National Eye Institute Visual Function Questionnaire (NEI VFQ-25) composite score increased for patients wearing PROSE devices at 6 months (Δ=+23 points, mean=82, p<0.001, two-tailed t test) with no significant decline among those still wearing a device at 5 years (Δ=-4 points, mean=78, p=0.22, two-tailed t test). At 5 years, those wearing (mean=78) had a higher NEI VFQ-25 than those not wearing (mean=70, p=0.029, two-tailed t test).


PROSE treatment offers continued benefit, as defined by improved visual function and continued device wear at 5 years, in patients with complex corneal disease. Patients with distorted cornea have a higher rate of continued wear at 5 years than patients with OSD, although this is not true among all subgroups within OSD.


Contact lens; Cornea; Ocular surface; Prosthesis; Vision

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