The Dry Eye Zone

Rebecca's Blog


Study: Limitations of PROSE (mostly about Fuch's and other endothelium-compromised patients)

This study lays out some specific cases where PROSE was not a success.


  • 6.4% failure rate (8 out of 125 eyes) seemed to me impressively low. However, I would really like to know more about what the follow-up period was.

  • 6 out of 8 failures were related to corneal edema and presumably endothelial issues (Fuch’s dystrophy patients or those with full thickness corneal transplants). Incidentally… for a long time my heart’s gone out to people with Fuch’s dystrophy who also have dry eye. It’s one of those combinations where holding fluid on the surface of the eye may be great for the surface but the eye is so compromised in other ways that it causes other even more serious problems elsewhere. Sigh!

  • 2 out of 8 failures related to too much crud on the lenses, obscuring vision. Mucous collection on lenses is a problem, for sure - solvable for some but not everyone.

Treatment Limitations With PROSE (Prosthetic Replacement of the Ocular Surface Ecosystem): One Centers Experience. Schear MJ1 et al, Eye Contact Lens. 2019 Apr 24.



The prosthetic replacement of the ocular surface ecosystem (PROSE) device is used to treat difficult-to-manage ocular surface disease (OSD) and ectasia. Previous studies have demonstrated positive treatment outcomes. This study aims to document treatment failures to better tailor treatment and address limitations with its use.


Retrospective chart review of consecutive PROSE fits performed at Northwell Health from 2012 to 2016. Reasons for patient discontinuation of treatment were documented, and potential risk factors for treatment failure were assessed.


The total number of eyes treated was 125. Fifty five eyes had ectasia, 67 had OSD, and 3 had both ectasia and OSD. A total of 8/125 (6.4%) of eyes failed treatment; 6/8 (75%) of failed treatments had worsening corneal edema, all of which had presumed risk factors for lower endothelial cell counts. Two eyes discontinued use secondary to intractable debris on the device, blurring vision. The most common diseases in patients failing therapy in descending order included: keratoconus and Fuch's dystrophy, ectasia after penetrating keratoplasty, and graft versus host disease. Those with presumed risks factors for lower endothelial cell counts (Fuch's dystrophy and patients with previous penetrating keratoplasty) were more likely to fail (22.2%) compared with those without a risk of a low endothelial cell count (1.6%).


Although PROSE use has high success, corneal edema secondary to endothelial dysfunction is a potential limitation that may lead to treatment failure. Patients with lower endothelial cell counts after penetrating keratoplasty or with Fuch's dystrophy were more likely to fail treatment.