PROSE for irregular corneas at a tertiary eye care center.

OBJECTIVE: The aim of this study was to report and discuss the clinical experience with PROSE (Prosthetic Replacement of Ocular Surface Ecosystem) practice at a tertiary eye care hospital. METHODS: Retrospective data of patients who were prescribed PROSE during April 2011 to March 2012 in a tertiary eye care center in south India were analyzed. Data collected include patient demographics, indications of scleral lens fitting, previous correction modality, PROSE parameters, best-corrected visual acuity (BCVA) with spectacles, and BCVA with PROSE at initial assessment and few hours of wear. The BCVA before (with glasses) and after PROSE fitting was recorded in logMAR units. RESULTS: The age of the patients ranged between 13 and 68 years (male:female 60:25) with a mean age of 32.44±13.45 years. Mean BCVA improved by 0.3 logMAR units (3 lines) after fitting with PROSE. There was a statistically significant difference between pre- and post-PROSE BCVA (P=0.0001). Failure of rigid gas-permeable lens fitting or intolerance was the common indication for PROSE in corneas with irregular astigmatism (refractive conditions). The other reasons for which PROSE was prescribed were pain, photophobia, comfort, ghosting of images, and frequent loss of smaller lenses. Toric scleral haptic was indicated in 62 eyes. The diameter, vault, and haptic measurements of PROSE in ocular surface disorders were much less and flatter than that of refractive conditions. CONCLUSIONS: PROSE device is a very useful alternative for irregular corneas to improve visual acuity, to improve comfort, and for symptomatic relief.

Tear ascorbic acid levels and the total antioxidant status in contact lens wearers: a pilot study.

AIMS: The tear ascorbate owing to its high concentration, functions as an effective antioxidant against the oxidative damage of cornea. Contact lens wearers (CLW) are prone to oxidative stress due to the lens-induced hypoxic conditions. A pilot study was done to compare the tear ascorbic acid level and the total antioxidant capacity give as in normal and CLW. MATERIALS AND METHODS: In this study 21 CLW (Mean age 23 +/- 3 years ; M-2, F-19), who were daily wear users, with duration of wear not more than four years, along with age-matched 28 controls (Mean age 28 +/- 3 ; M-15, F-13) were recruited in the study for collection of reflex tears using Schirmer's strip. Ascorbic acid in tears was determined using high-performance liquid chromatography (HPLC), total antioxidant capacity (TAC) and total protein assay by spectrophotometric analysis. RESULTS: CLW showed no significant change in the tear ascorbic acid levels (0.4 +/- 0.26 mM) compared to the control subjects (0.61 +/- 0.59 mM). The amount of ascorbic acid in tears did not correlate with the TAC or the total protein of the tears. The mean TAC in CLW was 0.69 +/- 0.16 mM, with a total protein of 1.35 +/- 0.46 mg/ml while in controls it was 0.7 +/- 0.18 mM and 1.21 +/- 0.47 mg/ml respectively. CONCLUSIONS: Soft contact lens wear did not show any significant change in tear ascorbic acid, TAC and total protein levels compared to controls.