Microcystic corneal oedema associated with over-wear of decentred orthokeratology lenses during COVID-19 lockdown

Figures & data

Table 1. Orthokeratology care solutions from Ophtecs Corporation (Tokyo, Japan)

Purpose	Product
Cleaning	O2 Daily Care Solution
Rinsing	Cleadew Dissolving & Rinsing Solution
Disinfecting	Cleadew GP Advanced Care System
Application before insertion and before removal to aid loosening bound lenses	Tiare W artificial tears

Table 2. Clinical findings from September 2018 to September 2019

Date		Refractive error	BCVA [UVA] (logMAR)	Topography (decentration)	Action
15 September 2018 (Baseline)	RE	−3.75/-1.00x175	0.02	/	Commenced lens wear
	LE	−4.00/-0.75x180	0.02	/
19 October 2018 (1-month)	RE	−1.75DS	0.00 [0.50]	< 0.50 mm	Increased target of 1.00D
	LE	−2.00DS	0.00 [0.64]	< 0.50 mm
11 December 2018 (3-month)	RE	pl	0.00 [0.00]	< 0.50 mm	Continued lens wear
	LE	−0.25D/-0.50x165	0.02 [0.02]	< 0.50 mm
10 March 2019 (6-month)	RE	−0.50/-0.50x100	0.00 [0.20]	< 0.50 mm	Increased target of 1.00D
	LE	−0.75DS	0.00 [0.24]	< 0.50 mm
18 May 2019	RE	+1.00/-1.00x10	0.04 [0.12]	< 0.50 mm	Continued lens wear
	LE	−0.25D/-0.25x85	0.00 [0.10]	< 0.50 mm
23 June 2019 (9-month)	RE	−0.25/-0.50x110	0.02 [0.10]	< 0.50 mm	Continued lens wear
	LE	−0.25/-0.50x95	0.02 [0.12]	< 0.50 mm
6 September 2019 (12-month)	RE	−0.25DS	0.04 [0.10]	< 0.50 mm	Continued lens wear
	LE	+0.25/-1.00x180	0.06 [0.10]	< 0.50 mm

BCVA—Best Corrected Visual Acuity; UVA—Unaided Visual Acuity.

Figure 1. Corneal topography indicating lens decentration. A: 15-month visit, B: 18-month visit. R-right eye, L-left eye. The Aladdin HW3.0 (Topcon Medical Systems. Inc., Oakland US) was used at 15-month visit, and the Medmont E300 (Version 6.1.2, Medmont Pty. Ltd., Camberwell Australia) was used at 18-month visit

Figure 2. Ocular findings showing corneal A: microcystic responses, B: corneal haze, and C: corneal staining when first noted. R-right eye, L-left eye. Images captures using Topcon slit-lamp biomicroscopy (SL-D7, Topcon Medical Systems Inc., Oakland, USA)

Table 3. Grading scale for orthokeratology lens decentration

Mild	< 0.50 mm	Clinically insignificant
Moderate	0.50–1.00 mm	Not clinically significant, if no associated symptoms
Severe	> 1.00 mm	Clinically significant