• Written By:
    Cornea/External Disease, Oculoplastics/Orbit

    In this retrospective analysis, the authors compared outcomes in patients treated with prosthetic replacement of the ocular surface ecosystem (PROSE) versus other standard-of-care treatments for postsurgical lagophthalmos and exposure keratopathy.

    Study design

    The authors retrospectively reviewed the charts of 45 patients (53 eyes) with postoperative lagophthalmos and exposure keratopathy. Causes of lagophthalmos included blepharoplasty, ptosis repair, eyelid reconstruction and skull base tumor resection. Visual outcomes were compared between patients who received PROSE (n=22) with those who received standard treatment regimens of lubrication, plugs and surgery (n=23).

    Secondary outcome measures included subjective improvement in vision and comfort and corneal slit-lamp examination findings.


    At baseline, visual acuity was significantly poorer in the PROSE versus standard group (0.58 vs. 0.27 logMAR). Patients who received PROSE had greater improvements in visual acuity from baseline (3-lines vs. no line) at 1 month after treatment. This improvement was sustained through 12 months. There were no differences in secondary outcome measures between PROSE and standard patients.


    There was likely significant selection bias, as patients receiving PROSE treatment had significantly more failed treatments than the standard care group (8.3 vs. 2.1). Corneal slit lamp examination findings were not quantified.

    Clinical significance

    This study shows PROSE treatment has utility after oculoplastic surgical procedures that cause lagophthalmos and exposure keratopathy. It may be of particular use in patients with more severe cases of postoperative lagophthalmos and exposure keratopathy.