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  • Patients undergoing incisional glaucoma surgery may benefit from PROSE devices

    Cornea/External Disease, Glaucoma

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    Review of: Glaucoma prevalence and glaucoma surgical considerations in Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) device use

    Duong A, Ertel M, Van Tassel S. Eye & Contact Lens: Science and Clinical Practice, February 2022

    This retrospective chart review at a single academic center identified patients with glaucoma or ocular surface disease who were candidates for a Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) device fitting and how those with glaucoma responded to the device.

    Study design

    PROSE devices are small, transparent domes made of gas-permeable plastic that fit under the eyelids and rest on the sclera, allowing oxygen to reach the eye's surface. When they are inserted, they are filled with sterile saline, creating a reservoir of fluid that bathes the ocular surface in artificial tears. In this study, of the 281 patients fit with the PROSE device between 2011 and 2017, 24 (8.5%) had a glaucoma diagnosis. Success in fitting the device was defined as comfortable daily wear without conjunctival erosion, trabeculectomy leakage, or bleb/device failure.

    Outcomes

    Patients fit with the PROSE device had a higher prevalence of glaucoma than the general population. The most common reason for needing the device was ocular surface disease. Those who underwent incisional glaucoma surgery (n = 5) had only a 60% success rate of fitting the PROSE device.

    Limitations

    This study was limited by the low number of patients undergoing both incisional glaucoma surgery and PROSE fitting. Patients with ocular surface disease also can have poor visibility to the optic nerve and iridocorneal angle which could have limited the diagnosis of glaucoma. This academic center, Weill Cornell Medicine in New York City, receives a large number of patients with thermal and chemical-related ocular surface injuries, which may not be representative of the overall population of patients undergoing PROSE fitting.

    Clinical significance

    This study highlights that incisional glaucoma surgery is not a contraindication to successful PROSE fitting. Custom adjustments can be made to avoid bleb- or device-related problems with PROSE. Patients with severe ocular surface disease should also undergo regular glaucoma surveillance.