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Jonas JB, Jonas RA, Bikbov MM, Wang YX, Panda-Jonas S. Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation. Prog Retin Eye Res 2023; 96:101156. [PMID: 36585290 DOI: 10.1016/j.preteyeres.2022.101156] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
Myopic axial elongation is associated with various non-pathological changes. These include a decrease in photoreceptor cell and retinal pigment epithelium (RPE) cell density and retinal layer thickness, mainly in the retro-equatorial to equatorial regions; choroidal and scleral thinning pronounced at the posterior pole and least marked at the ora serrata; and a shift in Bruch's membrane opening (BMO) occurring in moderately myopic eyes and typically in the temporal/inferior direction. The BMO shift leads to an overhang of Bruch's membrane (BM) into the nasal intrapapillary compartment and BM absence in the temporal region (i.e., parapapillary gamma zone), optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter, fovea-optic disc distance elongation, reduction in angle kappa, and straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers. Highly myopic eyes additionally show an enlargement of all layers of the optic nerve canal, elongation and thinning of the lamina cribrosa, peripapillary scleral flange (i.e., parapapillary delta zone) and peripapillary choroidal border tissue, and development of circular parapapillary beta, gamma, and delta zone. Pathological features of high myopia include development of macular linear RPE defects (lacquer cracks), which widen to round RPE defects (patchy atrophies) with central BM defects, macular neovascularization, myopic macular retinoschisis, and glaucomatous/glaucoma-like and non-glaucomatous optic neuropathy. BM thickness is unrelated to axial length. Including the change in eye shape from a sphere in emmetropia to a prolate (rotational) ellipsoid in myopia, the features may be explained by a primary BM enlargement in the retro-equatorial/equatorial region leading to axial elongation.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany; Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany.
| | - Rahul A Jonas
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Jonas JB, Spaide RF, Ostrin LA, Logan NS, Flitcroft I, Panda-Jonas S. IMI-Nonpathological Human Ocular Tissue Changes With Axial Myopia. Invest Ophthalmol Vis Sci 2023; 64:5. [PMID: 37126358 PMCID: PMC10153585 DOI: 10.1167/iovs.64.6.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose To describe nonpathological myopia-related characteristics of the human eye. Methods Based on histomorphometric and clinical studies, qualitative and quantitative findings associated with myopic axial elongation are presented. Results In axial myopia, the eye changes from a spherical shape to a prolate ellipsoid, photoreceptor, and retinal pigment epithelium cell density and total retinal thickness decrease, most marked in the retroequatorial region, followed by the equator. The choroid and sclera are thin, most markedly at the posterior pole and least markedly at the ora serrata. The sclera undergoes alterations in fibroblast activity, changes in extracellular matrix content, and remodeling. Bruch's membrane (BM) thickness is unrelated to axial length, although the BM volume increases. In moderate myopia, the BM opening shifts, usually toward the fovea, leading to the BM overhanging into the nasal intrapapillary compartment. Subsequently, the BM is absent in the temporal region (such as parapapillary gamma zone), the optic disc takes on a vertically oval shape, the fovea-optic disc distance elongates without macular BM elongation, the angle kappa reduces, and the papillomacular retinal vessels and nerve fibers straighten and stretch. In high myopia, the BM opening and the optic disc enlarge, the lamina cribrosa, the peripapillary scleral flange (such as parapapillary delta zone) and the peripapillary choroidal border tissue lengthen and thin, and a circular gamma and delta zone develop. Conclusions A thorough characterization of ocular changes in nonpathological myopia are of importance to better understand the mechanisms of myopic axial elongation, pathological structural changes, and psychophysical sequelae of myopia on visual function.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York, United States
| | - Lisa A Ostrin
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Nicola S Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Ian Flitcroft
- Centre for Eye Research, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
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Panda-Jonas S, Auffarth GU, Jonas JB, Jonas RA. Elongation of the Retina and Ciliary Body in Dependence of the Sagittal Eye Diameter. Invest Ophthalmol Vis Sci 2022; 63:18. [PMID: 36169948 PMCID: PMC9526358 DOI: 10.1167/iovs.63.10.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the elongation of the retina and ciliary body in relation to myopic axial elongation. Methods Using light microscopy, we histomorphometrically measured in enucleated human globes the length of the retina from the ora serrata to the optic disc borders. The total retinal length was the mean of the retinal length measurements obtained on both sides of the optic disc. We additionally determined the length of the ciliary body between the ora serrata and the scleral spur. Results The study included 174 eyes (mean age, 61.7 ± 14.8 years; range, 24-89 years) with a mean sagittal eye diameter of 25.9 ± 3.2 mm (range, 21.0-37.0 mm). Retinal length (beta, 0.81; nonstandardized regression coefficient B, 0.73; 95% confidence interval (CI), 0.65-0.81; P < 0.001) and ciliary body length elongated (beta, 0.49; nonstandardized regression coefficient B, 0.16; 95% CI, 0.12-0.20; P < 0.001) with a longer sagittal eye diameter. Retinal length and ciliary body length were associated with each other (beta, 0.34; nonstandardized regression coefficient B, 0.12; 95% CI, 0.07-0.17). Conclusions The retina elongates by 0.73 mm (95% CI, 0.65-0.81) and the ciliary body by 0.16 mm (95% CI, 0.12-0.20) for each millimeter of axial elongation. With the inner limiting membrane and retinal nerve fibers forming the only structures connecting the deeper retinal layers with the optic disc, retinal elongation may be associated with a stretching of the retinal nerve fibers, potentially leading to optic nerve damage in highly myopic eyes, and with an increased strain within the inner limiting membrane, potentially leading to an intraretinal elevation at the posterior pole with the sequel of a myopic maculoschisis.
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Affiliation(s)
- Songhomitra Panda-Jonas
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.,Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Gerd U Auffarth
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Jost B Jonas
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.,Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
| | - Rahul A Jonas
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
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Zhu MJ, Ding L, Du LL, Chen J, He XG, Li SS, Zou HD. Photopic pupil size change in myopic orthokeratology and its influence on axial length elongation. Int J Ophthalmol 2022; 15:1322-1330. [PMID: 36017053 DOI: 10.18240/ijo.2022.08.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To explore the photopic pupil size behavior in myopic children undergoing overnight orthokeratology (ortho-k) over 1-year period and its effects on the axial elongation. METHODS A total of 202 Chinese myopic children were enrolled in this prospective clinical trial. Ninety-five subjects in ortho-k group and eighty-eight subjects in spectacle group completed the 1-year study. Axial length (AL) was measured before enrollment and every 6mo after the start of ortho-k. The photopic pupil diameter (PPD) was determined using the Pentacam AXL and measured in an examination room with lighting of 300-310 Lx. Stepwise multiple linear regression analysis was used to identify variables contribution to axial elongation. RESULTS Compared with spectacle group, the average 1-year axial elongation was significantly slower in the ortho-k group (0.25±0.27 vs 0.44±0.23 mm, P<0.0001). In ortho-k group, PPDs significantly decreased from 4.21±0.62 mm to 3.94±0.53 mm after 1mo of lens wear (P=0.001, Bonferroni correction) and the change lasts for 3-month visit. No significantly change during the other follow-up visits was found (P>0.05, Bonferroni correction). The 4.81 mm PPD may be a possible cutoff point in the ortho-k group. Subjects with PPD below or equal to 4.81 mm tended to have smaller axial elongation compared to subjects with PPD above 4.81 mm after 1-year period (t=-3.09, P=0.003). In ortho-k group, univariate analyses indicated that those with older age, greater degree of myopia, longer AL, smaller baseline PPD (PPDbaseline) experienced a smaller change in AL. In multivariate analyses, older age, greater AL and smaller PPDbaseline were associated with smaller increases in AL. In spectacle group, PPD tended to be stable (P>0.05, Bonferroni correction) and did not affect axial growth. CONCLUSION PPDs experience significantly decreases at 1-month and 3-month ortho-k treatment. Children with smaller PPD tend to experience slower axial elongation and may benefit more from ortho-k.
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Affiliation(s)
- Meng-Jun Zhu
- Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China
| | - Li Ding
- Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China
| | - Lin-Lin Du
- Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China
| | - Jun Chen
- Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China
| | - Xian-Gui He
- Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China
| | - Shan-Shan Li
- Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China
| | - Hai-Dong Zou
- Shanghai Eye Disease Prevention & Treatment Center/Shanghai Eye Hospital, Shanghai 200040, China.,Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
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Five-Year cumulative Incidence and Progression of Myopic Maculopathy in a German population – results from the Gutenberg Health Study. Ophthalmology 2021; 129:562-570. [DOI: 10.1016/j.ophtha.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
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Zheng H, Ying X, He X, Qu J, Hou F. Defective Temporal Window of the Foveal Visual Processing in High Myopia. Invest Ophthalmol Vis Sci 2021; 62:11. [PMID: 34236385 PMCID: PMC8267181 DOI: 10.1167/iovs.62.9.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the temporal characteristics of visual processing at the fovea and the periphery in high myopia. Methods Eighteen low (LM, ≤ -0.50 and > -6.00 D) and 18 high myopic (HM, ≤ -6.00 D) participants took part in this study. The contrast thresholds in an orientation discrimination task under various stimulus onset asynchrony (SOA) masking conditions were measured at the fovea and a more peripheral area (7°) for the two groups. An elaborated perceptual template model (ePTM) was fit to the behavioral data for each participant. Results An analysis of variance with three factors (SOA, degree of myopia and eccentricity) was performed on the threshold data. The interaction between SOA and degree of myopia in the fovea was significant (F (4, 128) = 2.66, P = 0.036), suggesting that the masking effect had different temporal patterns between the two groups. The temporal profiles for the two groups were derived based on the ePTM model. The peak and the spread of the temporal window in the fovea were much lower and wider, respectively, in the HM group than that in the LM group (both Ps < 0.05). There was no significant difference in the peripheral temporal window between the two groups. Conclusions High myopia is associated with defective temporal processing in the fovea, captured by a flattened temporal window.
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Affiliation(s)
- Haiyan Zheng
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoxiao Ying
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Jia Qu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang Hou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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He X, Deng J, Xu X, Wang J, Cheng T, Zhang B, Zhao H, Luan M, Fan Y, Xiong S, Zhu J, Zou H, Xu X. Design and Pilot data of the high myopia registration study: Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM). Acta Ophthalmol 2021; 99:e489-e500. [PMID: 33377612 PMCID: PMC8359463 DOI: 10.1111/aos.14617] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the methodology and pilot data of the Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM). METHODS This is a population-based, prospective, examiner-masked study with annual follow-up. Patients are 4- to 18-year-olds with high myopia. The participants will fill out questionnaires and then undergo visual acuity, axial length (AL), intraocular pressure, ophthalmologist assessment, microperimetry, cycloplegic refraction, Pentacam, wavefront aberration, fundus, blood and saliva examinations. To describe the pilot data, intergroup differences were assessed with t-tests or analysis of variance and a logistic regression model was used to determine the independent factors associated with peripapillary atrophy (PPA). RESULTS Overall, 134 eyes of 79 participants met the pilot study recruitment criteria. The mean AL and spherical equivalent were 26.91 ± 1.07 mm and -9.40 ± 1.77 D, respectively. Peripapillary atrophy (PPA) (N = 112) and tessellated fundus (N = 67) were the most common fundus changes. The mean AL was significantly longer in PPA (27.08 ± 0.93 mm) than in non-PPA eyes (26.06 ± 1.31 mm; p < 0.001). Axial length (AL) (p = 0.041) was the only independent factor associated with PPA. Axial length (AL) was significantly longer in eyes with diffuse chorioretinal atrophy (N = 11; 28.02 ± 1.31 mm) than without myopic retinal lesions (N = 56; 26.48 ± 0.91 mm, p < 0.001) or with tessellated fundus (N = 67; 27.09 ± 0.97 mm, p = 0.012). The myopic degree was higher in eyes with diffuse chorioretinal atrophy than without myopic retinal lesions (-10.51 ± 2.76 D versus -9.06 ± 1.58 D, p = 0.039). CONCLUSION Peripapillary atrophy and tessellated fundus were common in children and adolescents with high myopia. Results from this prospective study will help to understand the mechanisms, development and prognosis of these changes and can guide early myopia screening.
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Affiliation(s)
- Xiangui He
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Junjie Deng
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Xian Xu
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Jingjing Wang
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Tianyu Cheng
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Bo Zhang
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Huijuan Zhao
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Mengli Luan
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Ying Fan
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Shuyu Xiong
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Haidong Zou
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Xun Xu
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
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Chen CA, Lin PY, Wu PC. Treatment effect of posterior scleral reinforcement on controlling myopia progression: A systematic review and meta-analysis. PLoS One 2020; 15:e0233564. [PMID: 32453804 PMCID: PMC7250442 DOI: 10.1371/journal.pone.0233564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background High myopia is a sight-threatening disease that causes axial length elongation and severe complications. Data on the benefits of posterior scleral reinforcement surgery in myopia control have been conflicting. The purpose of this study was to explore the treatment effect and complications of posterior scleral reinforcement in the treatment of myopia. Methods Articles were retrieved for relevant studies from inception to July 24, 2019, by PubMed, EMBASE, and Ovid. Analyses were conducted to compare the treatment effects of controlling spherical equivalent refraction and axial length elongation. The weighted mean difference and Hedges’ adjusted g were used to evaluate the treatment effects, with a random-effects model. Heterogeneity was quantified using I2 statistic and explored by subgroup analysis. Publication bias was addressed by funnel plots and Egger’s test. Results A total of 11 articles were included in this meta-analysis. On estimating the treatment effect, the mean differences of myopia progression and axial length changes between surgery and control groups were 0.41 diopters per year (95% CI 0.21 to 0.61; P < .001) and −0.17 mm per year (95% CI −0.22 to −0.11; P < .001). Subgroup analysis showed significant treatment effects of the single wide strip operation. Single-arm meta-analysis showed less annual axial elongation in children subgroup. These results were robust by sensitivity analysis. The incidence of some major complications in the operation group were significantly greater (5.8% vs 2.7% for myopic degeneration; 2.3% vs 1.6% for macular hemorrhage; 0.8% vs 0 for retinal detachment). Conclusion Posterior scleral reinforcement may be an effective surgery on controlling myopia progression by slowing both refraction and axial length change. However, frequent surgical complications should be considered. Further well-designed studies are needed to determine the long-term safety and efficacy.
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Affiliation(s)
- Chih-An Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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