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Prosthetic replacement of the ocular surface ecosystem (PROSE) for Terrien’s marginal degeneration: a case series

Poster Details

First Author: B. Wong CANADA

Co Author(s):    A. Garg   T. Trinh   S. Ramdass   J. Liao   A. Slomovic   C. Chan     

Abstract Details


Terrienメs marginal degeneration (TMD) is an uncommon peripheral thinning disorder of the cornea that causes reduced vision through progressive irregular astigmatism. We report on the advantages and challenges of the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) lens treatment in patients with advanced TMD.


Kensington Eye Institute, Toronto, Canada.


This is a retrospective case series of 6 eyes in 4 patients with advanced TMD who were fit with PROSE between 2018 to 2020. Patients were fit with trial PROSE lenses and adjustments to lens parameters were ordered based on the assessment of the lens fit on each eye. The customized lens was dispensed to each patient at a follow-up appointment. Each patientメs clinical notes were reviewed and data were collected on ocular diagnoses, symptoms, previous lens modalities attempted, visual acuities (VA) before and after PROSE, slit-lamp findings, corneal tomography scans, and PROSE fitting details.


All patients had attempted at least one other lens modality including spectacles, corneal gas permeable contact lenses (CLs), or conventional scleral CLs before PROSE. Some patients had corneal comorbidities, such as pseudopterygium and descemetocele, that contributed to intolerance to previous lenses and warranted additional fitting considerations. VAs improved with PROSE in all 6 eyes. Patients with structural corneal comorbidities achieved good visual improvement and lens tolerance with PROSE. Two eyes in 1 patient had non-corneal ocular comorbidities that limited PROSE efficacy. Another eye definitively discontinued PROSE wear due to limbal stem cell disease progression necessitating a limbal stem cell transplant.


The PROSE treatment can be an effective option to improve vision and comfort for patients with advanced TMD, even in the presence of other corneal comorbidities such as pseudopterygium. With its high degree of customizability, it is an appropriate alternative for patients who are intolerant to first-line therapeutic contact lens modalities for visual improvement.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, receives consulting fees, retainer, or contract payments from a competing company

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