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 Table of Contents  
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 471-473

Overnight orthokeratology lens-related corneal endothelium deficiency in a 23-year-old woman: A case report

Department of Optometry, Tianjin Medical University Eye Hospital, Tianjin Medical University Optometry College, Tianjin Medical University Eye Institute, Tianjin, China

Date of Submission04-Jul-2020
Date of Acceptance19-Jan-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Wei R Hua
251 Fukang Road, Nankai District, Tianjin
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2133_20

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More children select OK lens to control myopia. Corneal endothelial cells (CECs) were used to assess the safety of OK lens. We reported a unique case of CECs deficiency in a high myopic woman who wore OK lens for 8 years. She followed up irregularly and did not replace the lens in time. The lenses were covered with thick protein membrane and scratches. Her endothelial cells density (ECD) dropped significantly. It remained at low level until 3-year follow-up. In conclusion, there is a great need for patient education regarding the potential risks involved with the increasing popularity of OK lenses.

Keywords: Corneal endothelial cell, myopia, orthokeratology lens

How to cite this article:
Mei ZH, Ying Z, Ping LW, Hua WR. Overnight orthokeratology lens-related corneal endothelium deficiency in a 23-year-old woman: A case report. Indian J Ophthalmol Case Rep 2021;1:471-3

How to cite this URL:
Mei ZH, Ying Z, Ping LW, Hua WR. Overnight orthokeratology lens-related corneal endothelium deficiency in a 23-year-old woman: A case report. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:471-3. Available from: https://www.ijoreports.in/text.asp?2021/1/3/471/319990

Orthokeratology lens (OK) have been used to slow the progression of myopia.[1] The complications accompanying an OK lens that affect corneal endothelial cells (CECs) is a key issue. CECs are sensitive to hypoxia. They are used as a vital index to assess the safety of an OK lens.[2],[3] Modern OK lenses are made of high-oxygen-permeable materials that rarely affect CECs. Most of the studies have shown that over the short-term, an OK lens is safe and effective.[4],[5],[6] We describe a relatively unusual case of OK lens-related CECs deficiency in a woman who wore OK lens as long as 8 years.

  Case Report Top

A 23-year-old woman presented with blurred vision for a 1-month history. The best-corrected visual acuity (BCVA) was 0.5 in the right eye (RE) and 0.6 in the left eye (LE). She reported no previous history of surgery, systemic diseases, or family history. Her medical history only included three pairs of OK lenses manufactured by the Euclid corporation. The care system was the BOSTON care system with a 3-month replacement period. The baseline data and the parameters of the OK lens are as follows [Table 1].
Table 1: The baseline data of her eyes, and the parameters of the 3 pairs of OK lenses

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She had used antibiotics and antivirus eye drops prescribed by previous doctors for 2 weeks, however, the situation did not improve.

On initial examination in our hospital, there was central corneal edema of 4 × 5 mm2 in the RE. Several pigment keratic precipitates (KP) were scattered on the endothelium, and no aqueous flare or cells were found. Her subjective refractions were: RE, –10.00 – 2.00X005 = 0.5 and LE, –9.00–2.50X175 = 0.6. The cornea was too edematous to count the ECD in the RE. In the LE, ECD was 935 cells/mm2; Pentacam showed that central corneal thickness (CCT) was 667 μm in the RE and 544 μm in the LE. Confocal microscopy showed the CECs were edematous, and had cell polymegethism and polymorphism [Figure 1].
Figure 1: Initial eye examination results on February 4th, 2017. (a). Slit-lamp photographs of the central cornea edema. (RE). (b). Specular Microscope shows the corneal endothelial cell density count (ECD) decreased significantly. (LE. The RE was too edematous to count). (c). Confocal shows the endothelial cells were edematous, with polymegathism and polymorphism. (RE). (d). Central cornea thickness by Pentacam. (RE)

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The OK lenses were covered with a thick protein membrane and scratches [Figure 2].
Figure 2: The pictures of the OK lens. (a). Thick protein membrane (red arrow), especially in the RC area. Deep scratches on the surface of the lens. (RE). (b). The situation was similar to the RE, but mild. (LE)

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We diagnosed it as OK lens-related CECs deficiency. The patient was advised to discontinue OK treatment immediately. Topical steroids were applied and tapered according to the changes in edema.

The patient's BCVA, CCT, and ECD at each follow-up are as follows [Table 2].
Table 2: Patientfs BCVA, CCT and ECD at each follow-up

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  Discussion Top

Corneal endothelium deficiency is the most severe adverse response attributed to contact lens wear. Although it rarely happens, this complication has the potential to compromise vision. Overnight wear is another important factor as the cornea suffers from some degree of hypoxia, despite the high oxygen permeability of the contact lens. We focused on OK lens because there was no other history than the use of three pairs of OK lenses. Meanwhile, we used confocal imaging to differentiated Fuchs endothelial cornea deficiency and iridocorneal endothelial syndrome (ICE).

This girl had high myopia with partial reduction when using the OK lens, and partial reduction with single vision spectacles to obtain good VA in the daytime. Many authors[7],[8] have reported that the combination of partial reduction with OK lenses and spectacles is a safe and feasible option for correcting high myopia. However, they had only followed up for 5 years at most. Long time follow up is necessary.

Xie et al.[4] found that there were no significant changes in both corneal thickness and average ECD before and after 7 years of normatively wearing OK lenses. Cheung et al. showed a minimal effect on the developmental changes in endothelial morphology.[9] Nieto-Bona found though no significant changes in endothelial cell density were observed over time but polymegathism increased significantly.[10]

However, there was no follow-up after fitting the first and the third lens for this young girl. What is more, she did not replace the second lens in time. It lasted for nearly 5 years! The lenses were covered with severe protein membrane and scratches. Considering all these factors together, these two risks were most likely the main risk factors in our patient.

  Conclusion Top

Based on this unique case, there is a great need for patient education regarding the potential risks involved with the increasing popularity of OK lenses in children. Regular follow-up and replacement of the lenses are as important as fitting the OK lens properly. Ophthalmologists and optometrists should pay more attention to high myopia corrected with OK lenses.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Leo SW, Scientific Bureau of World Society of Paediatric O, Strabismus. Current approaches to myopia control. Curr Opin Ophthalmol 2017;28:267-75.  Back to cited text no. 1
Joyce NC, Zhu CC. Human corneal endothelial cell proliferation: potential for use in regenerative medicine. Cornea 2004;23 (8 Suppl):S8-19.  Back to cited text no. 2
Joyce NC. Proliferative capacity of the corneal endothelium. Prog Retin Eye Res 2003;22:359-89.  Back to cited text no. 3
Guo X, Xie P. Corneal thickness and endothelial observation for youth myopia patients fitted with ortho-k lens for seven years. Zhonghua Yan Ke Za Zhi 2014;50:9-13.  Back to cited text no. 4
Zhong X, Chen X, Xie RZ, Yang J, Li S, Yang X, et al. Differences between overnight and long-term wear of orthokeratology contact lenses in corneal contour, thickness, and cell density. Cornea 2009;28:271-9.  Back to cited text no. 5
Liu YM, Xie P. The safety of orthokeratology--a systematic review. Eye Contact Lens 2016;42:35-42.  Back to cited text no. 6
Charm J, Cho P. High myopia-partial reduction orthokeratology (HM-PRO): Study design. Cont Lens Anterior Eye 2013;36:164-70.  Back to cited text no. 7
Zhou J, Xie P, Wang D, Guo X, Yang L. The long-term clinical effects of orthokeratology in high myopia children. Zhonghua Yan Ke Za Zhi 2015;51:515-9.  Back to cited text no. 8
Cheung SW, Cho P. Does a two-year period of orthokeratology lead to changes in the endothelial morphology of children? Cont Lens Anterior Eye 2018;41:214-8.  Back to cited text no. 9
Nieto-Bona A, Gonzalez-Mesa A, Nieto-Bona MP, Villa-Collar C, Lorente-Velazquez A. Long-term changes in corneal morphology induced by overnight orthokeratology. Curr Eye Res 2011;36:895-904.  Back to cited text no. 10


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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