Utility of Prosthetic Replacement of the Ocular Surface Ecosystem Treatment in the Management of Patients with Refractory Intrinsic Evaporative Dry Eye Disease

Background: Dry eye disease is a multifactorial disease whose pathogenic mechanisms have not been investigated rigorously. The objective of this study was to evaluate the utility of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment in the management of patients with intrinsic evaporative dry eye refractory to conventional therapies. Design: A retrospective clinical cohort study of patients with intrinsic evaporative dry eye disease refractory to conventional therapies seen between July 1, 2009 and May 31, 2012 at USC Eye Institute, a tertiary referral center. Participants: 36 eyes of 21 patients with intrinsic evaporative dry eye that completed PROSE fitting were included. Main outcomes measures: Outcomes based on pre and post PROSE visual acuity and visual function. Bestcorrected visual acuities were measured using a Snellen chart under standardized conditions. Visual function was assessed using the Ocular Surface Disease Index survey, a 12-item questionnaire that quantifies the severity of ocular discomfort and level of vision-related function. Results: Mean visual acuity improved from 0.33 ± 0.40 logMAR pre-PROSE to 0.10 ± 0.16 logMAR post-PROSE (Z=-4.3, p<0.0001, n=36). Thirteen of 21 patients completed pre-PROSE and post-PROSE surveys. Survey scores improved from 63.61 ± 15.76 pre-PROSE to 24.84 ± 29.58 post-PROSE (Z=-2.9, p=0.004, n=13). Conclusion: The results of our study strongly suggest PROSE treatment improves visual acuity and function in patients with refractory intrinsic evaporative dry eye disease and could serve as a viable alternative to more invasive