Structural changes associated to orthokeratology: A systematic review.

Sánchez-García, Alicia; Ariza, Miguel A.; Büchler, Philippe; Molina-Martin, Ainhoa; Piñero, David P (2021). Structural changes associated to orthokeratology: A systematic review. Contact lens and anterior eye, 44(4), p. 101371. Elsevier 10.1016/j.clae.2020.10.001

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


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.


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.


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.

Item Type:

Journal Article (Review Article)


10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Musculoskeletal Biomechanics

UniBE Contributor:

Ariza Gracia, Miguel Angel, Büchler, Philippe


500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health
600 Technology > 620 Engineering








Philippe Büchler

Date Deposited:

27 Jan 2021 11:09

Last Modified:

05 Dec 2022 15:43

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Corneal epithelium Corneal sensitivity Keratocyte Orthokeratology Polymegethism




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