PROSE Treatment in Atypical Ocular Graft-Versus-Host Disease. Issue 11 (November 2016)

• Record Type: Journal Article
• Authors: Chiu, Gloria B.; Theophanous, Christos; Irvine, John A.
• Is Part Of: Optometry and vision science. Volume 93:Issue 11(2016)
• Publication Date: 2016-11
• Subjects: graft-versus-host disease (GvHD) -- persistent epithelial defects (PEDs) -- Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) -- scleral lenses -- systemic immunosuppression; Optometry -- Periodicals; Physiological optics -- Periodicals; Vision disorders -- Periodicals; 617.7505
• DOI: 10.1097/OPX.0000000000001003
• Languages: English
• ISSNs: 1040-5488

Abstract

ABSTRACT: Purpose: To report a case of persistent epithelial defects in a patient with ocular chronic graft-versus-host disease that required coordinated modulation of systemic immunosuppressive treatment and overnight wear of Prosthetic Replacement of the Ocular Surface Ecosystem (BostonSight PROSE, Needham, MA) devices to achieve ocular surface healing. Case Report: The case of a 38-year-old male patient who presented with a 2-year history of ocular chronic graft-versus-host disease, ocular burning, pain, light sensitivity, and a 3-week history of bilateral corneal epithelial defects is presented. Standard therapies and an initial PROSE treatment utilizing customized scleral lenses were unsuccessful in resolving his ocular complications. A second trial of PROSE treatment involving overnight wear of the devices in combination with increased systemic immunosuppressant therapy ultimately allowed ocular surface healing and improved his discomfort, vision, and quality of life. Conclusions: Sight-threatening complications of ocular chronic graft-versus-host disease often require a multidisciplinary approach. Persistent corneal epithelial defects may require increased systemic immunosuppression and extension of PROSE treatment to overnight wear.