Glaucoma surgical considerations for PROSE lens use in patients with ocular surface disease

• Surgical treatment of glaucoma in PROSE lens wearers is a challenge.
• Anteriorly positioned patch grafts after tube surgery may predispose to poor lens fitting.
• Pars plana tube placement can prevent poor lens fitting in scleral-lens-dependent patients.

PurposeTo examine challenges of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment in patients with glaucoma drainage implants (GDI) and the surgical management of patients where both GDI and PROSE treatment are indicated.MethodsA retrospective noncomparative observational study was performed to investigate the outcomes of 7 eyes of 6 patients that required PROSE lens wear and GDI implantation.ResultsGroup A consisted of 2 cases where PROSE lens wear was problematic due to scleral surface irregularities following GDI placement. These included changes in surface morphology caused by the elevated scleral patch graft tissue adjacent to the corneal limbus in one case and the presence of two anteriorly located shunts in the other. Group B consisted of 3 eyes where the previously placed GDI led to poor lens alignment due to the proximity of the lens edge to the scleral graft. Group C consisted of 2 cases where both patients underwent placement of the GDI in the pars plana and insertion of the drainage tube 3–3.5 mm from the limbus in order to facilitate PROSE lens use. The posterior location of the tube and patch allowed for proper PROSE device alignment over the ocular surface.ConclusionsSurgical considerations and prior planning for GDI placement allows PROSE lens use for management of ocular surface disease. Pars plana tube placement with a posteriorly placed patch graft, instead of anterior chamber tube positioning with more anterior graft, enables adequate lens wear in scleral-lens-dependent patients.