Treatment effect of posterior scleral reinforcement on controlling myopia progression: A systematic review and meta-analysis

Chen, Chih-An; Lin, Pao‐Yen; Wu, Pei-Chang

doi:10.1371/journal.pone.0233564

Cited by 14 publications

(12 citation statements)

References 24 publications

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“…Our long-term outcomes showed that PSR followed by vitrectomy can effectively restore the anatomical structure of macula and improve the BCVA of MF patients. It was reported that vitrectomy alone could improve BCVA in 80%-84% of MF eyes [15,17] , and PSR alone could improve BCVA in 66%-75% of MF eyes at the end of follow-up [18][19] . While in our current study, up to 41 eyes (93%) achieved significant improvement in BCVA at the last follow-up visit.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy

Huang¹,

Wei²,

Duan³

2022

Int J Ophthalmol

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AIM: To report the long-term outcome of posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic myopic foveoschisis (MF). METHODS: The records of 27 patients (44 eyes) treated with posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic MF were retrospectively reviewed. The best-corrected visual acuity (BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings and complications were analyzed. RESULTS: Forty-four eyes of 27 patients were included in this study. The follow-up period was 47.98±18.23mo (24-83mo). The mean preoperative BCVA (logMAR) was 1.13±0.63, and the mean postoperative BCVA was 0.30±0.33 at the last visit. There showed a significant improvement in BCVA postoperatively (P<0.001). Postoperative BCVA in 41 eyes (93%) was improved compared with the preoperative one. Forty-two eyes (95.45%) got total resolution of the MF after surgery. The remaining two eyes (4.55%) got partial resolution of foveoschisis. The preoperative foveal thickness was 610.45±217.11 μm and the postoperative foveal thickness at the last visit was significantly reduced to 177.64±55.40 μm (P<0.001). The preoperative axial length was 29.60±1.71 mm, and the postoperative axial length was 29.74±1.81 mm at the last visit. There was no significant increase in axial length within 47.98±18.23mo of follow-up (P=0.562). There was no recurrence of foveoschisis or occurrence of full-thickness macular hole during the whole follow-up period. CONCLUSION: For pathologic MF, PSR followed by vitrectomy is an effective procedure to improve the visual acuity and the anatomical structure of macula. It can also stabilize the axial length for a long time.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy

Huang¹,

Wei²,

Duan³

2022

Int J Ophthalmol

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“…In recent years, posterior scleral reinforcement (PSR) surgeries have been revived to cope with fast elongation of highly myopic eyes ( 11 ). These studies have reported different surgical effect sizes and safety profiles ( 12 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…These studies have reported different surgical effect sizes and safety profiles ( 12 – 14 ). In general, these scleral reinforcement surgeries seem to be more or less effective on controlling rapid axial elongation ( 11 ); and the PSR procedures seem to be well tolerated ( 15 ). In contrast to the number of studies on PSR efficacy, few study investigated the effect of reinforcing material on PSR ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Considerations of Patching Material for Posterior Scleral Reinforcement Surgery

et al. 2022

Front. Med.

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PurposeTo characterize biomechanical properties of genipin-crosslinked human dura mater as reinforcing material for posterior scleral reinforcement (PSR) and to compare it with crosslinked human sclera.MethodsDonor dura mater and sclera were crosslinked in the same optimized genipin solution. Resistance to enzyme degradation for both materials were investigated by exposing the materials to accelerated enzyme degrading. Elastic modulus and tensile strength were measured by biomechanics testing equipment. Crosslinked human dura mater was used as reinforcing patch in PSR on 57 adult pathologic myopic eyes. The patients were followed up for an average 3 years. The main outcome was eye globe axial length change and safety profile of the reinforcing material.ResultsCrosslinked dura mater demonstrated similar percentage weight loss to crosslinked sclera when exposed to enzymatic solution. Dura mater has higher density than sclera. The retaining elastic modulus after enzyme exposure was 72.02 MPa for crosslinked dura mater while 53.88 MPa for crosslinked sclera, 34% greater for crosslinked dura mater, P = 0.0186). At the end of 3 years follow-up, the mean globe axis of the surgery eyes was reduced by 1.29 mm (from 30.81 to 29.51 mm, P < 0.0001, paired t-test). Visual acuity (BCVA logMar) improved by 0.10 logMar unit which is an improvement of five letters (P = 0.0184, paired t-test). No material specific complication was noted.ConclusionCrosslinked human dura mater may be superior to crosslinked human sclera as reinforcing material for PSR to manage progression of high myopia. This material was well tolerated on human eye.

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“…Posterior scleral reinforcement (PSR) surgery is currently the operation most commonly performed to control myopia progression [ 7 ]. A scleral graft is placed over the macular area by insertion of the inferior oblique muscle, and the two ends of the graft are sutured to the superior and inferior nasal quadrants, wrapping the posterior pole.…”

Section: Introductionmentioning

confidence: 99%

Clinical Feasibility and Safety of Scleral Collagen Cross-Linking by Riboflavin and Ultraviolet A in Pathological Myopia Blindness: A Pilot Study

Sun

et al. 2022

Ophthalmol Ther

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Introduction To investigate the feasibility and safety of scleral ultraviolet A (UVA) cross-linking (scleral CXL) on pathologically blindness. Methods This was a prospective, observational clinical study. Five patients with monocular blindness due to pathological myopic maculopathy were enrolled. Eyes with best corrected visual acuity (BCVA) under 0.05 were defined as experimental eyes. The fellow eyes were defined as control eyes. Patients first underwent posterior scleral reinforcement (PSR) surgery in the control eye. Thereafter, scleral CXL surgery was performed in the experimental eye on the same day. Visual acuity, BCVA, slit lamp biomicroscopic examination, intraocular pressure measurement, corneal specula microscopies, axis length measurement, funduscopy with pupil dilation, color fundus photography, full-field flash electroretinography, optical coherence tomography, and color Doppler flow imaging were performed at baseline, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Results No signs of inflammation were observed after operation and throughout the follow-up period. Retinoschisis was improved, while choroidal neovascularization fibrosis and retinal and choroidal atrophy were unchanged after scleral CXL. There were no statistically significant differences in the ophthalmic artery, central retinal artery, and posterior ciliary artery parameters of color Doppler flow imaging or in retinal thickness, within experimental and control eyes, at baseline, 1 week, 1 month, 3 months, or 12 months ( P > 0.05). Conclusions This pilot study verified the feasibility and safety of scleral CXL on human blindness. The UVA-CXL on the sclera of human eyes seems to have the same effect as PSR in preventing progressive pathological myopia in the future. Trial Registration Chinese Clinical Trial Registry (ChiCTR2100042422).

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Treatment effect of posterior scleral reinforcement on controlling myopia progression: A systematic review and meta-analysis

Cited by 14 publications

References 24 publications

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy

Biomechanical Considerations of Patching Material for Posterior Scleral Reinforcement Surgery

Clinical Feasibility and Safety of Scleral Collagen Cross-Linking by Riboflavin and Ultraviolet A in Pathological Myopia Blindness: A Pilot Study

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