Posterior Scleral Reinforcement to Prevent Progression of High Myopia

Abstract

Background:Myopia has become a global public health problem. High myopia is linked to pathologic myopia (PM). As the severity of myopia increases, excessive axial elongation of the globe exerts a biomechanical stretch on the posterior pole, followed by a series of retinopathy which can lead to marked visual impairment. Posterior scleral reinforcement (PSR) is the only way that may have the potential to prevent the progression of axial elongation. Some scholars expressed satisfaction with the efficacy and safety of PSR. In contrast, other surgeons had negative conclusions on the outcomes for the surgery.Objectives:The aims of this review are to provide an update on the current knowledge of posterior scleral reinforcement to prevent progression of high myopia and to discuss clinical trials examining the potential utility of PSR in treating this disease.Methods:We searched Ovid MEDLINE, Embase, PubMed and China National Knowledge Infrastructure (CNKI) (all years to 1 July 2019). We also conducted a gray literature search and handsearched reference lists of included studies and pertinent review articles.Results:26 clinical trials were included. 20 trials were designed as only one eye of each patient had posterior scleral reinforcement surgery. After 3 to 5 years of follow-up, the results are very satisfactory. 6 randomized controlled trials, which have conservatively treated groups, showed statistically significant differences between the eyeball axial length progression in the study group and the control group, where surgery was not performed. Most clinical trials reached a positive influence. But the efficacy of different clinical trials varies greatly.Conclusions:PSR, is safe and effective to slowdown myopia progression, especially for high myopia.

Longitudinal Changes in Macular Optical Coherence Tomography Angiography Metrics in Primary Open-Angle Glaucoma With High Myopia: A Prospective Study

“…The SCP is located near the large retinal vessels in the RNFL; hence, its density might be less sensitive to alterations associated with axial elongation and thinning of the retina in high myopia. [41][42][43][44] Our findings indicated that the deep retina is more vulnerable to microvascular changes over time than the SCP in POAG eyes with high myopia. These findings remained significant after exclusion of all POAG eyes that developed VF deterioration.…”

Association of Aberrant Posterior Vitreous Detachment and Pathologic Tractional Forces With Myopic Macular Degeneration

“… 24 Although existing strategies primarily revolve around preventing or retarding the onset and progression of myopia, there are also effective interventions for PS (macular buckling) and MTM (pars plana vitrectomy). 24 , 51 , 52 Treatment for PS and MTM are generally reserved for later stages where there is a foveal detachment or full-thickness macular hole necessitating urgent intervention to avoid permanent vision loss. 53 , 54 By establishing a possible association between PS/MTM and MMD, this may imply that early detection and early treatment of PS/MTM, prior to the current late-stage indications, may potentially prevent MMD development or progression.…”

Myopie de l’enfant

“…L'étude LAMP (low-concentration atropine for myopia progression) [17] est le premier essai randomisé en double aveugle (contre placebo), utilisant l'atropine à faible concentration, permettant de fournir des preuves solides pour étayer son rôle dans le contrôle de la myopie. Il a résolu la controverse sur le dosage de l'atropine en démontrant une réponse dépendante de la concentration d'atropine (0,05 %, 0,025 % et 0,01 %) dans le Depuis, la technique a été modifiée dans les années 1970, mais elle reste assez invasive [19].…”