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Case Reports
. 2022 Apr 14:26:101520.
doi: 10.1016/j.ajoc.2022.101520. eCollection 2022 Jun.

Regression of corneal opacity and neovascularization in Stevens-Johnson syndrome and Toxic Epidermal Necrolysis with the use of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment

Jennifer Liao  1 , Bita Asghari  2 , Karen G Carrasquillo  2
Affiliations
Case Reports

Regression of corneal opacity and neovascularization in Stevens-Johnson syndrome and Toxic Epidermal Necrolysis with the use of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment

Jennifer Liao et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To report two cases demonstrating the regression of corneal neovascularization and clearing of corneal opacification in patients with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) undergoing prosthetic replacement of the ocular surface ecosystem (PROSE) treatment.

Observations: Four eyes of 2 patients were analyzed. Regression of neovascularization and clearing of corneal opacification was observed in both patients. All 4 eyes demonstrated improvement in visual acuity with treatment. With treatment, both patients ultimately discontinued all prescribed topical therapies. It was discovered upon review of these cases that all 4 eyes were managed with PROSE devices designed with back-surface channeled haptics.

Conclusions and importance: There currently is no known literature reporting on long-term regression of corneal neovascularization or clearing of corneal opacity in SJS or TEN patients with the use of scleral prosthetic devices. This report of 2 cases highlights the improvement in corneal function with PROSE treatment involving the use of channeled designs in patients with SJS or TEN. More research is needed to better understand how PROSE or scleral lens design features affect patient outcomes and why some patients may show regression in corneal neovascularization.

Keywords: Corneal neovascularization; Corneal opacity; PROSE treatment; Scleral lenses; Stevens-Johnson syndrome; Toxic epidermal necrolysis.

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Figures

Fig. 1
Fig. 1
(A) A schematic of a PROSE device with back-surface channels in the haptics of the device on eye. (B) A PROSE device with a prominent channel viewed under diffuse white light slit lamp under low magnification. (C) A high magnification, diffuse white light slit lamp image of a PROSE device on a plunger with an arrow pointing to a channel, seen as back-surface grooves.
Fig. 2
Fig. 2
Diffuse white light images in low and high magnification of the right eye of patient described in Case 1 at baseline (A), with mild peripheral corneal neovascularization. Regression and resolution of peripheral corneal neovascularization is visualized at 8 months (B) following continued daily wear of a fluid-ventilating PROSE design with back-surface channels.
Fig. 3
Fig. 3
(A) Corneal neovascularization and haze of the left eye observed by indirect illumination at baseline of patient in case 1. (B) Progressive regression of corneal neovascularization and haze is visualized at 1 month (C), 4 months (D), and 8-month (D) follow-up, with daily wear of a PROSE device designed with back surface channels.
Fig. 4
Fig. 4
(A) Diffuse white light of the right cornea of patient in case 2 showing regression of central corneal haze at 5 months, (B) 10 months, and (C) 17 months of daily wear of a fluid-ventilating PROSE design with back-surface channels.
Fig. 5
Fig. 5
(A) Diffuse white light of the left eye cornea with diffuse corneal neovascularization and haze at baseline for case 2. Progressive regression in corneal haze and neovascularization is visualized at (B) 5 months, (C) 10 months, and (D) 17 months with daily wear of a fluid-ventilating PROSE design with back-surface channels.
See this image and copyright information in PMC

References

    1. Kohanim S., et al. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - a comprehensive review and guide to therapy. I. Systemic disease. Ocul Surf. 2015;14(1):2–19. - PubMed
    1. Gregory D. The ophthalmic management of acute Stevens-Johnson Syndrome. Ocul Surf. 2008;6(2):87–95. - PubMed
    1. Ciralsky J., Sippel K., Gregory D. Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson Syndrome and toxic epidermal necrolysis. Curr Opin Ophthalmol. 2013;24:321–328. - PubMed
    1. Borchers A.T., Lee J.L., Naguwa S.M., et al. Stevens-Johnson syndrome and toxic epidermal necrolysis. Autoimmun Rev. 2008;7:598–605. - PubMed
    1. Kohanim S., et al. Acute and chronic ophthalmic involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis – a comprehensive review and guide to therapy. II. Ophthalmic disease. Ocul Surf. 2016;14(2):168–188. - PubMed

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