Posterior Scleral Reinforcement for The Treatment of Myopic Foveoschisis

Background: This study aimed to investigate the clinical effectiveness of posterior scleral reinforcement for the treatment of myopic foveoschisis.Methods: This was a prospective study of 32 eyes from 20 patients with myopic foveoschisis treated with posterior scleral reinforcement using genipin-cross-linked donor sclerae . The length of the scleral strip used for the surgery was designed to be 1.5-times the axial length of the eye, whereas its width was 0.4-times the axial length of the eye. The optical coherence tomography images, spherical equivalent of refractive error, axial length, best corrected visual acuity, electroretinogram findings, and intraocular pressure of the patients were assessed postoperatively. Results: The mean duration of follow-up was 17.80 ± 8.74 months. The differences between the spherical equivalent of refractive error, best corrected visual acuity, axial length, and electroretinogram findings recorded preoperatively and those measured postoperatively were statistically significant (p＜0.05). The final reduction in axial length was 1.64 ± 0.85 mm. At the end of the follow-up, optical coherence tomography showed essential foveal reattachment in 30 eyes (93.75%), partial reattachment in two eyes (6.25%), and closure of macular holes in seven eyes (77.78%). No retinal detachment, vitreous haemorrhage, or other serious complications occurred following the surgery. Conclusions: Posterior scleral reinforcement with genipin-cross-linked sclera showed safe and effective outcomes for the treatment of myopic foveoschisis during a follow-up period of at least one yearTrial registration:ChiCTR1800020012

A Three-Dimensional-reconstruction-based study on the ocular volume of Chinese children with high myopia

Background Highly myopic eyes differ in morphology from emmetropic eyes, and the correct estimation of the vitreous volume is difficult. To explore an effective method to estimate ocular volume using refractive factors in children. Methods This is a retrospective study of children with high myopia who visited the Shenzhen Shekou People’s Hospital (July-December 2018) before undergoing posterior scleral reinforcement surgery. Data on refractive factors and ocular 3D reconstruction imaging based on high-end CT were collected for linear correlation and linear regression analyses. Results Ten patients (20 eyes) were included. There are nine males and one female. They were 4 to 12 years of age. The spherical equivalent ranges from + 0.25 to -20.00 D. The cylindrical equivalent ranges from − 0.50 to -6.25 D. The AL(axial length, AL) ranges from 21.78 to 33.90 mm. The corneal curvature (mean) ranges from 42.44 to 46.75. The 3D reconstruction of the CT images shows that the ocular volume ranges from 4.591 to 10.988 ml. The ocular volume of the 20 eyes decreases with the increase of diopter and total curvature, both presenting a linear trend, with the Pearson correlation coefficients being − 0.776 (P < 0.001) and − 0.633 (P = 0.003), respectively. The ocular volume of the 20 eyes increases with the increasing AL, also presenting a linear trend, with the Pearson correlation coefficient being 0.939 (P < 0.001). Conclusions In children, the ocular volume is negatively and linearly correlated with the diopter and curvature, and positively and linearly correlated with the AL.

Shaping Eyeballs by Scleral Collagen Cross-Linking: A Hypothesis for Myopia Treatment

The global prevalence of myopia has brought to the attention of the different eye and vision specialists, who make way to control its progression. Evidence have shown that a proactive reshaping of the eyeball is the core point of myopia developing process, which particularly includes the weakening, thinning, and expanding of the sclera. Thus, the sclera is considered to be a prime target for therapeutic manipulation in halting progressive myopia. In the past decades, corneal collagen cross-linking has been applied in clinical practice for treating aberrant corneal remodeling diseases. In this article, we hypothesize that scleral collagen cross-linking (SXL) has a huge potential in stabilizing myopic process by shaping the eyeball and preventing the aberrant scleral remodeling. In contrast with the current methods of optometry correction, such as physiotherapy, pharmacotherapy, spectacles, contact lenses, refractive surgeries, etc., eyeball-shaping method using SXL is a fundamental intervention which aims at the pathogenesis of progressive visual loss of myopia. Compared with the current posterior scleral reinforcement, the most advantage of SXL is that there is no allotransplant into the myopic eye, which means less expenditure, lower risk, and easier to handle in operating.

Investigation of Macular Choroidal Thickness and Blood Flow Change by Optical Coherence Tomography Angiography After Posterior Scleral Reinforcement

Purpose: This work aimed to study the effect of posterior scleral reinforcement (PSR) on choroidal thickness (CT) and blood flow.Methods: This study included 25 eyes of 24 patients with high myopia ( ≤ -6.0 dioptres or axial length ≥ 26.0 mm) who underwent PSR surgery. All patients completed the 1-month follow-up visit. Myopic macular degeneration (MMD) was graded according to the International Meta-Analysis for Pathologic Myopia (META-PM) classification based on color fundus photographs. Swept-source optical coherence tomography angiography (SSOCTA) was performed to investigate CT, choroidal perfusion area (CPA), and choriocapillaris perfusion area (CCPA) change following PSR surgery.Results: The distribution of MMD categories was 9 (36.0%) in category 1, 10 (40.0%) in category 2, and 6 (24.0%) in category 3 or 4. MMD severity was strongly correlated with CT (all P &lt; 0.01) and CPA (all P &lt; 0.04). Postoperative CT at each sector increased significantly at 1 week's follow-up, compared to preoperative measures (all P &lt; 0.05). Postoperative CPA at subfoveal, superior, inferior, and nasal sectors also increased significantly 1 week after PSR surgery (all P &lt; 0.05). Moreover, the increased CT, CPA, and CCPA remain after PSR surgery at 1 month's follow-up, but the difference was not statistically significant.Conclusions: We demonstrated that the CT and choroidal blood flow increased significantly in patients with high myopia who underwent PSR surgery in a short period of time. In addition, the CT and CPA were independently associated with MMD. However, whether the transient improvement of the choroidal circulation could prevent long-term progression of high myopia warrants further study in the future.

The effectiveness and safety of modified posterior scleral reinforcement in Chinese children with high myopia

Background To evaluate the effectiveness and safety of modified posterior scleral reinforcement in controlling the progression of myopia in patients with high myopia and provide reference information on surgical treatment for these patients.Methods The study included 32 patients (55 eyes) with high myopia who were treated with modified posterior scleral reinforcement and were followed up at 3 months, 6 months, 1 year and 2 years after the operation.The axial length, refractive error, best corrected visual acuity (BCVA) and fundus colour photographs after the operation were compared with those before the operation, and whether there were any complications was recorded.Results The axial length of the eye increased by 0.07 mm, 0.12 mm, 0.31 mm and 0.19 mm at 3 months, 6 months, 1 year and 2 years after the operation, respectively. The refractive error increased by 0.05 D, 0.28 D, 0.53 D and 0.50 D at 3 months, 6 months, 1 year and 2 years after the operation, respectively, and the differences were not significant (P > 0.05). There were no statistically significant changes in BCVA, but there was an upward trend. No severe complications occurred.Conclusion Modified posterior scleral reinforcement can effectively delay the worsening of the ocular axis and refractive error, without severe complications in the short term.

A 3D-reconstruction-based study on the ocular volume of Chinese children with high myopia

Background: Highly myopic eyes differ in morphology from emmetropic eyes, and the correct estimation of the vitreous volume is difficult. To explore an effective method to estimate ocular volume using refractive factors in children.Methods: This is a retrospective study of children with high myopia who visited the Shenzhen Shekou People's Hospital (July-December 2018) before undergoing posterior scleral reinforcement surgery. Data on refractive factors and ocular 3D reconstruction imaging based on high-end CT were collected for linear correlation and linear regression analyses.Results: Ten patients (20 eyes) were included. There are nine males and one female. They were 4 to 12 years of age. The spherical equivalent ranges from +0.25 to -20.00 D. The cylindrical equivalent ranges from -0.50 to -6.25 D. The axial length ranges from 21.78 to 33.90 mm. The corneal curvature (mean) ranges from 42.44 to 46.75. The 3D reconstruction of the CT images shows that the ocular volume ranges from 4.591 to 10.988 ml. The ocular volume of the 20 eyes decreases with the increase of diopter and total curvature, both presenting a linear trend, with the Pearson correlation coefficients being -0.776 (P<0.001) and -0.633 (P=0.003), respectively. The ocular volume of the 20 eyes increases with the increasing axial length, also presenting a linear trend, with the Pearson correlation coefficient being 0.939 (P<0.001).Conclusions: In children, the ocular volume is negatively and linearly correlated with the diopter and curvature, and positively and linearly correlated with the axial length.

Results with Posterior Scleral Reinforcement for Progressive Highly Myopic Children in Hungary

Purpose We have been performing posterior scleral reinforcement in our ophthalmological department since 1992 on progressive highly myopic eyes. Here, we report on our results with this technique in the foregoing 7 years in a retrospective comparative design. Methods Thirty-eight eyes of 32 patients, operated according to Snyder-Thompsonʼs method, were enrolled in this study, and a control group of 9 age- and myopia-matched childrenʼs 14 eyes was built for comparison. Pre- and postoperative best-corrected visual acuity, subjective refractive error (spherical equivalent of spectacle dioptres), and axial length were recorded. Changes within groups were calculated, as well as baseline parameters and their changes during follow-up, and compared between the groups. Correlation analysis was performed to identify factors that could influence myopia progression. Results Myopic progression was significantly lower in the operated than in the nonoperated group, both in terms of mean annual axial length as well as refractive error changes (0.21 ± 0.08 mm versus 0.49 ± 0.19 mm and 0.18 ± 0.29 D versus 0.6 ± 0.33 D, respectively). Mean overall visual improvement was more explicit in operated eyes as compared to those left untreated (0.15 ± 0.09 versus 0.01 ± 0.1). No association of any factor with myopia progression could be identified. We encountered no serious or lasting complications. Conclusion In our clinical practice, posterior scleral reinforcement according to Snyder-Thompson proved to be a safely applicable and effective surgical method to stop or significantly retard pathological increases in axial length and dioptres, and thus can help prevent the onset of myopic degenerative lesions, and irreversible visual impairment in the long run.

A customized posterior scleral reinforcement for myopic macular hole with retinal detachment and posterior staphyloma: A case report

The author describes a customized posterior scleral reinforcement, its manufacturing method, the rationale of its therapeutic effect, and the surgical technique of its implantation. A 54-year-old female patient with a case history of myopic macular hole with retinal detachment and posterior staphyloma, refractory to pars plana vitrectomy and peeling of internal limiting membrane, underwent posterior scleral reinforcement treatment. Retinal reattachment and macular hole closure were obtained. Best corrected visual acuity increased from light perception to 20/160 Snellen. The pars plana vitrectomy is mandatory to remove vitreoretinal tractions and epiretinal membranes; furthermore, the internal limiting membrane peeling makes retina less rigid. However, it may not be sufficient to allow retinal reattachment and it plays no preventive role in limiting posterior staphyloma progression. The rationale of posterior scleral reinforcement is to reduce retinal stretching, to contain posterior staphyloma, and to limit its progression over time.