Filling in the Defect: Overnight PROSE Treatment of Persistent Epithelial Defects

Nova Southeastern University, Davie, Florida, USA

Neurotrophic Keratopathy can result in persistent epithelial defects from poor corneal healing secondary to corneal desensitization and decreased lacrimation. This case report highlights the benefits of day and night PROSE wear in treating persistent epithelial defects resistant to conventional therapies. A 78 year old female presented with a neurotrophic persistent epithelial defect in her left eye associated with Herpes Zoster Ophthalmicus that started 1 year ago. She had previously tried copious lubrication, autologous serum tears, bandage SCLs, amniotic membranes, and multiple temporary tarsorraphy without success. This case is unique because the patient had a persistent epithelial defect that lasted for over 1 year despite numerous therapies. Additionally, PROSE and Scleral wear are normally limited to daytime wear due to the high risk of infection and corneal hypoxia. This presentation shows that there are benefits to overnight wear as well. In this case, improvement in both the size and depth of the defect could be measured with increased patient comfort and decreased burning sensation after 1 week of overnight PROSE treatment. Discussion. The PROSE device aids in healing persistent epithelial defects via three main mechanisms. It provides protection from external shearing forces, constant hydration to the ocular surface via its fluid reservoir, and increased oxygenation through its channels for fluid-tear exchange. Concisely, treatment of persistent epithelial defects with day and night PROSE wear should be considered when other conventional therapies have failed.