Optometry Research Today is a free monthly online journal that collates and summarizes the latest research about Optometry, including details on myopia, optometric practice, therapy.

Case report: the occurrence of fibrillary lines in overnight orthokeratology.

Cheung SW, Cho P, Bron AJ, Chui V, Chan B

School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China. sopeggy@polyu.edu.hk

BACKGROUND: To report the occurrence of concentric fibrillary lines in the central corneas of a 13-year-old girl during overnight orthokeratology. METHODS: Observational case report. RESULTS: The initial refractive errors and keratometric readings (flattest/steepest meridians) of the patient were -6.00/-0.50 x 180 and 45.25/46.20 D, respectively, in the right eye and -5.50 DS and 44.90/45.80 D, respectively in the left eye. She underwent orthokeratology for myopic control, with a target reduction of 4.00 D myopia. A pair of DreimLens lenses was prescribed to be worn on a nightly basis and spectacles were worn by day. The same orthokeratology lenses were used throughout the monitoring period. Corneal topography showed well-centred treatment zones but persistent peripheral corneal staining due to trichiasis. A faint, peripheral pigmented brownish corneal arc and bundles of fine concentric fibrillary lines were observed in the central cornea about 12 months after commencing lens wear. In view of the persistent corneal staining due to trichiasis, she was advised to stop the orthokeratology treatment after 16 months of lens wear and was prescribed 1-Day Acuvue daily disposable contact lenses. The pigmented line disappeared after 2 months of hydrogel lens wear, while the fibrillary lines took 10 months to resolve. CONCLUSIONS: Fibrillary lines are a feature of the normal cornea thought to represent the arrangement of the subbasal, epithelial nerve plexus. We hypothesize that orthokeratology lens wear stimulates an altered epithelial migration pattern and a structural reorganisation of the subbasal nerve plexus in relation to this. This is assumed to account for the concentric pattern of fibrillary lines seen in our patient. The lines had no effect on vision and resolved over a period of 10 months following cessation of orthokeratology lens wear.

Published 21 August 2006 in Ophthalmic Physiol Opt, 26(5): 525-31.
Full-text of this article is available online (may require subscription).

© 2005-2008 Optometry Research Today. All Rights Reserved.