Modified Posterior Scleral Reinforcement as a Treatment for High Myopia in Children and Its Therapeutic Effect

Effect and safety posterior scleral reinforcement on controlling myopia in children: a meta-analysis

PURPOSE

The aim of this meta-analysis was to assess the efficacy of posterior scleral reinforcement (PSR) on the control of pediatric myopia. Electronic databases were systematically searched.

METHODS

Standardized mean differences (SMDs) of outcomes were calculated. Eight studies with 357 patients with pediatric myopia were included. The SMD for the increase in mean axial length (AL) in the PSR and control group was - 1.19 (95% CI - 1.71, - 0.68).

RESULTS

The SMD for decrease of best-corrected visual acuity (BCVA) LogMAR in the PSR and control group was 0.85 (95% CI 0.28, 1.43). The SMD for change in intraocular pressure (IOP) at the time of surgery and at the end of the follow-up period in the PSR group was - 0.01 (95% CI - 0.48, 0.47).

CONCLUSION

This meta-analysis indicates that PSR surgery may be an effective therapeutic strategy to control the progression of myopia in childhood with acceptable adverse effects.

Surgical treatment of Pitt-Hopkins syndrome associated with strabismus and early-onset myopia: Two case reports

BACKGROUND

Pitt-Hopkins syndrome (PTHS; MIM #610954) is a rare genetic neurological disorder. Myopia and strabismus have been reported in approximately 50% of PTHS patients. No studies have reported details about the required surgery for PTHS with strabismus and early-onset myopia. Here, we retrospectively reviewed the surgical management of two patients with PTHS combined with strabismus and/or early-onset myopia.

CASE SUMMARY

A 5-year-old girl presented with congenital esotropia and left eye myopia, and the second girl was a 5-year-old girl who presented with intermittent exotropia. Genetic testing performed on both patients showed a mutation in transcription factor 4, which is a diagnostic marker of PTHS. The first girl underwent bilateral medial rectus recession combined with posterior scleral reinforcement (PSR) in the left eye and the second patient underwent bilateral lateral rectus recession strabismus surgery. We made key innovations in surgical timing and strategy, and the results were satisfactory. The combination of strabismus and PSR surgery is an innovative strategy for patients with both strabismus and early-onset myopia.

CONCLUSION

Early treatment of strabismus and myopia positively influence motor development and should be included in rehabilitation programs for patients with PTHS.

Clinical effect of rigid gas permeable (RGP) contact lens in improving vision and controlling myopia progression of unilateral high myopic children

BACKGROUND

The aim of this study was to explore the clinical effect of the RGP contact lens in improving vision and controlling myopia progression of the unilateral high myopic children.

METHODS

In this retrospective analysis case series study, we analyzed the clinical data for 23 subjects with unilateral high myopic children under 6 years old, with the spherical equivalent refractive error of the myopic eye from -5.0 D to -12.0 D, who were enrolled from the outpatient clinic at Beijing Tongren Hospital, China. Fourteen subjects could successfully fit the RGP contact lens, and nine subjects used the spectacle lens. Complete ocular examination was performed at the first visit at the clinic and every three months during the follow-up period.

RESULTS

In the RGP group, the change of axial length (AL) of the high myopic eye was from 25.62 ± 1.31 mm to 25.69 ± 1.31 mm after 12 months. The change of spherical equivalent (SE) was from -8.73 ± 2.54 D to -8.48 ± 2.77 D. The best corrected visual acuity (BCVA) improved from 0.24 ± 0.18 to 0.78 ± 0.26. In the spectacle group, the change of AL was from 24.76 ± 0.56 mm to 24.94 ± 0.71 mm. The change of SE was from -6.16 ± 2.86 D to -9.45 ± 2.06 D. The improvement of BCVA was from 0.52 ± 0.15 to 0.72 ± 0.23.

CONCLUSIONS

Wearing RGP lens in the children with unilateral high myopia is a safe, convenient and effective method to improve the best corrected vision and controlling myopia progression.

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 < 0.01) and CPA (all P < 0.04). Postoperative CT at each sector increased significantly at 1 week's follow-up, compared to preoperative measures (all P < 0.05). Postoperative CPA at subfoveal, superior, inferior, and nasal sectors also increased significantly 1 week after PSR surgery (all P < 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.

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-Thompson's method, were enrolled in this study, and a control group of 9 age- and myopia-matched children's 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.

The efficacy of modified posterior scleral reinforcement with round scleral patches in Chinese children with high myopia

PURPOSE

To observe the efficacy of modified Snyder-Thompson posterior scleral reinforcement with round scleral patches in Chinese children with high myopia.

METHODS

This retrospective study included 46 Chinese children with high myopia (72 eyes) who underwent modified Snyder-Thompson posterior scleral reinforcement (PSR) with round scleral patches and 43 Chinese children with high myopia (67 eyes) who wore only spectacles as a control group. Both groups attended a follow-up at 3 years. Axial length (AL), spherical equivalent (SE), best-corrected visual acuity (BCVA), and full ocular assessment results were evaluated at the initial and final visits. Complications were recorded.

RESULTS

AL had increased by 0.29 ± 0.33 mm in the PSR group and 0.82 ± 0.33 mm in the control group (P < 0.0001) at the final follow-up. The change in the SE was 0.31 ± 0.81 D in the PSR group and 2.25 ± 1.02 D in the control group (P < 0.0001). A decrease of 0.02 ± 0.11 LogMAR was found in the control group, and a change of 0.22 ± 0.35 LogMAR was found in the PSR group. No serious complications due to PSR surgery occurred.

CONCLUSIONS

Modified Snyder-Thompson PSR surgery with round scleral patches can effectively limit the progression of axial elongation in Chinese children with high myopia. The operation is safe, causes little damage, and can be customized.

Posterior Scleral Reinforcement to Prevent Progression of High Myopia

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.