| Título: | Safety in Corneal Refractive Therapy for myopia control |
| Autores: | Batres Valderas, Laura ; Bodas Romero, Julia ; Carracedo Rodríguez, Juan Gonzalo |
| Tipo de documento: | texto impreso |
| Editorial: | Professional publications, 2020 |
| Dimensiones: | application/pdf |
| Nota general: | info:eu-repo/semantics/openAccess |
| Idiomas: | |
| Palabras clave: | Estado = Publicado , Materia = Ciencias Biomédicas: Medicina: Oftalmología , Materia = Ciencias Biomédicas: Óptica y optometría: Lentes de contacto , Materia = Ciencias Biomédicas: Óptica y optometría: Optometría , Tipo = Artículo |
| Resumen: |
In recent years, orthokeratological correction has been proposed as a method for controlling myopia in children and adolescents. This is based on the fact that orthokeratological lenses modify peripheral refraction from hyperopic to myopic. The role of peripheral refraction in controlling axial growth has been described in many studies. Orthokeratological correction creates a flattening zone in the center of the cornea and makes the peripheral zone steeper. Optical correction is associated with these changes and depends on the correct position of the lens on the surface of the cornea during the night. Potapova et al. Studied the effect of CRT lenses (Paragon) and found statistically significant keratometric and topographic changes. Lu et al., studying the effect of hyperopic CRT lenses, found a twisting of the cornea in the center and a flattening of the middle periphery, which completely disappeared after 28 hours after stopping the use of the lenses. The author also refers to the results of studies by other authors who studied changes in the profi le of the cornea during the use of CRT lenses. The corneal epithelium is the most affected tissue. Choo et al. conducted animal studies to examine the effect of CRT lenses on the corneal epithelium and found that there is a progressive thinning of the central zone and thickening of the mid-peripheral zone with increasing time of lens wear. In a human eye study, Wang et al. established the thinning of the central part of the cornea after the first night of using the lenses by 5.1±4.5%. Other authors found a 7.3% thinning of the epithelium and a 13% thickening of the middle periphery after one month of CRT lens use. These changes returned to their original values 3 days after the lens was discontinued. Nieto-Bona et al. studied the effect of using orthokeratological lenses on the cornea using confocal microscopy. They found no significant changes in either the endothelium or the density of the stromal nerve fibers during the month of wearing CRT lenses (Paragon). The results of studies and other authors coincided. The author of the article cites a number of studies conducted in the study of the sensitivity of the cornea, biomechanical properties, the factor of corneal resistance and showed the absence of statistically signifi cant changes in comparison with the cornea not subjected to orthokeratological correction. It also provides a review of articles on the refractive effect of ortholes. In particular, a number of authors report the correction of myopia up to –7.0D using CRT lenses (Koffl er et al) and stable and complete correction in myopia up to 6.0D with astigmatism up to 1.5D. The possibility of correcting myopia with astigmatism using orthokeratological lenses of a special toric design is discussed. The author of the article provides data on 123 cases of microbial keratitis described in the literature from 1997 to 2007. Most cases have occurred in East Asia in children aged 9 to 15 years, mainly due to improper lens use, failure to follow doctor’s instructions, and lens use regimen (over a year). The most common infections were acanthamoeba and pseudomone. Today, the incidence of keratitis when using orthokeratological lenses is estimated at 7.7 per 10,000 people, and according to other authors – 4.1 cases per 10,000 users. The author of the article describes other complications of orthokeratology, noting that they depend to a large extent on the quality and oxygen transmission of the lenses. The author pays attention to the issues of “dry” eye and provides data that when using orthokeratological lenses, the syndrome of “dry eye” and its markers are much less pronounced than when using daytime soft lenses. He emphasizes that this fact is a signifi cant advantage of night lenses over day wear lenses. Most of the changes on the surface of the cornea caused by orthokeratology lenses are reversible when they are discontinued. The following are two clinical cases. The author concludes that if the appearance of a central islet on the topogram during lens wear may be a manifestation of epitheliopathy, it is important to use an artificial tear to reduce the epithelial reaction. If it is impossible to eliminate central epitheliopathy, orthokeratology should be stopped. |
| En línea: | https://eprints.ucm.es/id/eprint/64229/1/Safety%20in%20CRT%20manuscript.pdf |
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