Purpose To study the safety and efficacy of posterior scleral reinforcement (PSR) combined with phakic intraocular lens (PIOLs) implantation for highly myopic amblyopia in children. Methods This study included eight highly myopic children (11 eyes) who failed in conventional therapy for amblyopia using various combination of spectacles, contact lenses, and intensive patching before enrollment into this study. They were treated sequentially with PSR and PIOL implantation, and were followed up for 3 years after surgery. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) in LogMAR, spherical equivalent power (SE), and complications were evaluated. Results Before surgery, the mean UCVA was 1.59 ± 0.33, BCVA, 0.74 ± 0.37, SE, À 17.57 ± 5.56D, the axial length (AL), 30.09±2.18 mm. After PSR, BCVA improved one line in three patients, the rest were unchanged, and AL was unchanged among all cases. Six eyes of three patients were implanted with an iris-claw PIOL and five eyes of five patients were implanted with a posterior PIOL. After completion of treatment, the mean UCVA was 0.44 ± 0.21, BCVA 0.38±0.24, SE À 0.54±0.74 D, and AL 30.35±2.29 mm. No patient experienced complications. Conclusion Combined PSR and PIOL implantation treatment for highly myopic amblyopia in children is safe and effective.

Purpose To evaluate the position of iris-claw phakic intraocular lens (ICPIOL) in highly myopic eyes by Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM). Methods Nine eyes of five patients aged 31710 years with average spherical equivalent of À16.0475.46 D (range À7.88 to À 22.88 D) were enrolled in this prospective study and implanted with Verisyse ICPIOLs (AMO). The anterior segment was evaluated by SP and UBM preoperatively and for at least 1 month postoperatively. The statistical significance may be questionable due to the limited number (nine) of eyes.Results By SP and UBM, the distance between corneal endothelium and lens (anterior chamber depth) preoperatively was 3.1070.14 and 3.0770.11 mm, respectively; between ICPIOL and corneal endothelium (pseudo-anterior chamber depth), 1.8870.09 and 1.9970.12 mm, respectively; between lens and posterior surface of ICPIOL (IL), 0.7670.13 and 0.6770.06 mm, respectively; between superior optic edge and iris (SOEI), 0.2370.23 and 0.5870.24 mm, respectively; between inferior optic edge and iris (IOEI), 0.0770.13 and 0.4170.22 mm, respectively; between ICPIOL haptics and the angle of anterior chamber (HA), 0.9070.17 and 1.4570.13 mm, respectively. ACD was well correlated between the two methods, but PACD, IL, OEI, HA were not. The postoperative measures, except IL, were significantly different between the two methods. Conclusion The differences between measurements by SP and UBM reveal the ICPIOL's position variations with change of body position. Nevertheless, it seems adequate that space is maintained between ICPIOL and corneal endothelium, angle, and crystalline lens. The ICPIOL implanted in phakic eyes seems a safe alternative for treatment of high myopia.

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