Purpose

To summarize the peer-reviewed literature on corneal structural changes after orthokeratology (OK) and to analyze the quality of the studies published.

Methods

An exhaustive search was carried out in the databases Pubmed MEDLINE, Web of Science and Scopus. Original studies in English, with a cohort or experimental design and analyzing the cellular and structural changes of the cornea after OK fitting for myopia correction were selected. The NewCastle-Ottawa Assessment Scale (NOS) tool was used to analyze the quality of the studies selected.

Results

The search provided a total of 1837 articles, of which 12 were selected following the inclusion and exclusion criteria. All studies had good quality according to the NOS tool (mean 7.58 ± 1.31). The mean ± standard deviation follow-up period of lens wear in the studies evaluated was 19.27 ± 33.97 months. The following reversible changes after OK have been reported: reduction in central epithelial basal cells, an increase in height and especially in width of superficial epithelial cells, as well as an increase in central stromal thickness and in the number of active keratocytes. Concerning corneal endothelium, only changes in terms of polymegathism were reported that were compatible with those observed for other types of contact lens wear. In relation to corneal sensitivity, there was a reduction during the use of OK, as well as in the nervous density of the sub-basal plexus at the central level, with some contradictory outcomes concerning the reversibility of these changes.

Conclusion

OK produces reversible structural changes in the central epithelium and central anterior corneal stroma, as well as a decrease in the nerve density of the sub-basal plexus and corneal sensitivity. The quality of published studies evaluating these aspects is good, although more studies are needed to evaluate longer follow-up changes.

中文翻译：

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与角膜塑形术相关的结构变化：系统评价

目的

总结关于角膜塑形术 (OK) 后角膜结构变化的同行评审文献，并分析已发表研究的质量。

方法

在 Pubmed MEDLINE、Web of Science 和 Scopus 数据库中进行了详尽的搜索。选择英语原创研究，采用队列或实验设计，分析近视矫正OK拟合后角膜的细胞和结构变化。纽卡斯尔-渥太华评估量表 (NOS) 工具用于分析所选研究的质量。

结果

搜索共提供 1837 篇文章，其中 12 篇是根据纳入和排除标准选出的。根据 NOS 工具，所有研究的质量都很好（平均 7.58 ± 1.31）。在评估的研究中，镜片佩戴的平均 ± 标准偏差随访期为 19.27 ± 33.97 个月。已经报道了 OK 后的以下可逆变化：中央上皮基底细胞减少、高度增加，尤其是浅表上皮细胞的宽度增加，以及中央基质厚度和活性角质细胞数量增加。关于角膜内皮，仅报道了与其他类型的隐形眼镜佩戴观察到的变化一致的多发性巨变。关于角膜敏感性，在使用 OK 期间有所降低，

结论

OK 在中央上皮和中央前角膜基质中产生可逆的结构变化，以及基底丛神经密度和角膜敏感性的降低。评估这些方面的已发表研究的质量很好，尽管需要更多的研究来评估更长的随访变化。