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Am J Ophthalmol. 2019 Jan 18. pii: S0002-9394(19)30015-7. doi: 10.1016/j.ajo.2019.01.006. [Epub ahead of print]

Prosthetic Replacement of the Ocular Surface Ecosystem Treatment for Ocular Surface Disease in Pediatric Patients with Stevens-Johnson Syndrome.

Author information

1
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
2
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; BostonSight, Needham, Massachusetts.
3
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. Electronic address: Hajirah_Saeed@meei.harvard.edu.

Abstract

PURPOSE:

To report the outcomes of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment in pediatric patients with chronic ocular surface disease associated with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).

DESIGN:

Retrospective, interventional case series METHODS: Patients ages 18 or younger seen in consultation for PROSE treatment at a single center between January 1992 and December 2016 with a history of SJS/TEN were reviewed. Demographics, etiology of SJS/TEN, age at treatment milestones, best corrected visual acuity (BCVA) at treatment milestones and treatment failures were recorded. BCVA at the initial presentation visit was compared to BCVA at the time of PROSE device dispense, and the last recorded visit.

RESULTS:

27 females and 22 males were reviewed. Reported etiology was an antibiotic (n=19), anti-epileptic (n=9), anti-pyretic (n=9), other (n=3) and unknown (n=9). The mean age was 6.4 years at disease onset, and 9.3 years at time of initial presentation. The mean duration of follow up was 5.45 years. The median BCVA at the initial presentation was 0.6 logMAR (20/80 Snellen), and was significantly improved to 0.18 logMAR (20/30 Snellen) at the time a PROSE device was dispensed (p < 0.0001). The median BCVA at the last recorded visit was significantly improved to 0.18 logMAR (20/30 Snellen, p = 0.0004). There were 15 patients who failed PROSE treatment (30.6%).

CONCLUSIONS:

PROSE treatment is feasible in over two-thirds of pediatric patients with chronic ocular surface disease related to SJS/TEN and results in significant improvement in vision that is durable over a period of many years.

PMID:
30664843
DOI:
10.1016/j.ajo.2019.01.006

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