The effect of orthokeratology in corneal scar from infectious ulcers – Two case reports

We report two adolescents who developed Pseudomonas aeruginosa (PsA) keratitis following orthokeratology (Ortho-K) lens wear. This study aimed to investigate the efficacy and safety of reintroducing high oxygen permeability (high Dk, 180) Ortho-K lenses in such cases. After successful treatment of the infections, a scar formed in corneal visual axis. The best-corrected visual acuity (BCVA) post-healing was 0.0 and 0.3 logMAR, respectively. Both patients resumed Ortho-K for myopia control and were closely monitored with visual acuity, refraction, slit-lamp examination, corneal topography, and anterior segment optical coherence tomography (AS-OCT). In Case 1, a 13-year-old girl achieved visual acuity of 0.0 logMAR in the affected eye 21 days after reintroduction, with topography showing significant corneal flattening over the scarred area. In Case 2, a 16-year-old girl showed BCVA improvement from 0.3 to approximately 0.22 logMAR after one month, with AS-OCT revealing marked epithelial thinning and redistribution from 84 µm to 35 µm. These findings suggest that high Dk Ortho-K lenses demonstrate potential efficacy and safety in reshaping corneas with pre-existing scars from microbial keratitis. Despite its promising functional visual outcomes, these results underscore the need for careful patient selection and close monitoring. Further research is warranted to establish the long-term safety and efficacy of this approach in patients with corneal scar.