Clinical observation of orthokeratology lens in the treatment of mild and moderate myopia / 中国基层医药

Objective@#To observe the clinical effects and safety of orthokeratology(OK) lens in the treatment of mild and moderate myopia, and to evaluate the effects on the myopia control.@*Methods@#The study included a total of 166 eyes in 83 myopia children who were treated in Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University from January 2014 to December 2014.They were randomly divided into two groups according to the digital table, 43 cases(86 eyes) in the observation group underwent standard OK lens, and the other 40 cases(80 eyes) in the control group were given common spectacles.The patients were followed up for two years.The uncorrected visual acuity, corneal curvature and ocular surface in the, observation group were examined, and diopter, axial length were examined in the two groups.@*Results@#The visual acuity of the observation group improved significantly at 1 day, trended to be stable at 1 week, and then was basically stable within 1 year, but decreased at 2 years.After 3 months, the mean corneal curvature[(41.93±1.12)D]was significantly lower than before orthokeratology[(43.56±1.44)D], and the difference was statistically significant(t=11.539, P<0.05). However, the effect didn’t persist without continued OK lens wear 1 month later.Compared with the control group, the growth of the diopter and axial length in the observation group were significantly slower(t=16.784, P<0.05; t=5.623, P<0.05). At the initial wearing, 34% of the observation group occurred corneal epithelial injury, but they all recovered by stop wearing and appropriate medication.With the prolong of wear time, the proportion of injury reduced.@*Conclusion@#Uncorrected visual acuity of mild and moderate myopia children wearing OK lens can significantly improve at 1 day, then is basically stable after 1 year, but declines within 2 years, which indicates the need for timely replacement of the lens.Long-term wearing is effective and safe to control the development of myopia.

A Case of Cataract Surgery in an Epikeratophakia Patient

PURPOSE: To report a case of cataract surgery in an epikeratophakia patient. CASE SUMMARY: A 59-year-old female with a history of epikeratophakic surgery 20 years ago complained of decreased visual acuity of both eyes for several months. She had nucleosclerotic and posterior subcapsular types of cataracts. Phacoemulsification and posterior capsule intraocular lens implantation were performed in both eyes. During surgery, corneal edema was especially prominent at the cornea with epikeratophakic lenticules in both eyes. In the left eye, severe corneal edema after one day of surgery was observed; however, after one week, corneal edema had subsided and visual acuity of both eyes had improved. CONCLUSIONS: When it necessary that cataract surgery is performed in patients with epikeratophakic lenticules, it is important to anticipate the corneal edema intraoperatively and postoperatively. Moreover, the surgeon should consider the acute calculation of the target refraction of intraocular lens in an epikeratophakia patient.

Long Term Follow-Up of Epikeratophakia in the Pediatric Aphakia

We performed 3 cases of epikeratoplasties on two pediatric aphakic patients who were intolerable to contact lenses & spectacles. These epikeratoplasties were performed in accordance with the Kaufman-McDonald Epikeratophakia Method using the commercially available frozen and dried Kerato-Lens (Allergan Medical Optics), the lenticule of which was rehydrated at the time of surgery. The cataract extractions were performed at 3 months after birth on both eyes of the congenital cataract & at 18 months after birth on the traumatic cataract that had developed at 14 months after birth. The epikeratoplasties for the eyes with congenital cataract were performed at 24 months on the right eye and at 16 months after birth on the left eye respectively. The epikeratoplasty for the traumatic cataract eye was performed at 28 months after birth. The 3 grafts have remained successful over the follow-up period of 4 to 6 years. The right eye of congenital cataract case had myopic shift of 3.75D and best corrected visual acuity of 0.2 during 5-year of follow-up period and the other left eye had myopic shift of 4.75 D and best corrected visual acuity of 0.7 during 6-year of follow-up period. The traumatic cataract case had myopic shift of 1.0 D and best corrected visual acuity of 0.05 during 4-year of follow up period. In view of this, it is considered that the epikeratoplasty is of an effective treatment in correcting the refractive error in the pediatirc aphakia patients who intolerable to contact lens and in whom difficulty exists in determining whether an intraocular lens implantation is appropriate or not.

Experimental and clinical studies on heteroepikeratophakia / 眼科

In the experimental study 5 cases of heteroepikeratophakia (HEP) (human to monkey) were done. The results showed that 4 HEP of experimental monkeys were found to be transparent in 6～24 months after operation. One of five experimental monkeys failed to have a transparent HEP because of epithelia implantation between donor lenticule and host cornea in the 3rd month after operation. In clinical study, HEP (monkey to human) was performed on 2 patients with aphakia. The visual acuity of these patients were improved because the transparent HEP was achieved. Either in experimental or in clinical study the immunological rejection was not found.

Histopathological findings in human epikeratophakia lenticules / 眼科

Six human epikeratophakia lenticules were remo- ved 1 to 23 months after refractive keratoplasty for aphakia(2)and myopia(3).The myopic group in- cluded one epi-lens treated with ArF-excimer laser for hyperopia.Causes of removal were epithelial de- fect(4),edema of host cornea(1)and overcorre- ction(1),The epi-lens stroma showed a central regular fibrillar structure with a low keratocyte den- sity.Electronmicroscopy revealed preserved cytoplas- mic organelles and nuclear appearance.Lymphocytes and other mono-nuclear cells were absent,Bowan's membrane was normal in all cases.Breaks were not seen while a slight wavy appearance and occasionally focal bends occurred.The epithelium was somewhat irregular and changing in thickness.In the peripher- al wound region stromal and epithelial irregularities were evident.

2 Case of Epikeratopkakia in the Adult Aphakia

One of the indications for epikeratophakia is monocular aphakia intolerant of spectacles and contact lens correction and unsuited for intraocular lens implantation for whatever reason. The procedure involves suturing a lamellar corneal stromal tissue of a human donor eye prelathed for corrective power onto the recipient cornea whose epithellum has just been removed. We performed the epikeratophakia procedure on two patients who were included in the above indication on May 26, 1988. Through the first 6 months of postoperative period, both the graft and recipient tissues remained clear with excellent optical quality, with corrected visual acuity of 0.4 at 1 month, 0.6 at 3 month and 0.8 at 6 month postoperative period respectively. The average increase of corneal curvature was 10.5 diopters and induced refractive error was within 1.5 spherical equivalent diopters after the 6 month period. No significant postoperative compications have been encountered.

Epikeratophakia for Adult Aphakia

Epikeratophakia is a newly developed refractive corneal surgery for the correction of aphakic vision. Two aphakic patients have received hyperopic epikeratophakia grafts. Three months postoperatively, two patients had visual acuities of 0.6 without spectacle overcorrection. Epikeratophakia appears to be effective for the correction of adult aphakia.