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

Abstract

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.

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

“…5 ). This result was consistent with previous studies [ 9 , 29 ], reflecting that PSR can only improve short-term blood flow and had no long-term effect. Although the difference between experimental and control eyes was not statistically significant, we can speculate that scleral CXL has the same effect as PSR, both improving or maintaining blood flow in the posterior pole to a certain extent.…”

“…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. A recent study revealed that PSR may maintain the microcirculation of eyes with posterior staphyloma and thereby stabilize the best-corrected visual acuity [ 8 , 9 ].…”

Retinal and Choroidal Vascular Perfusion and Thickness Measurement in Diabetic Retinopathy Patients by the Swept-Source Optical Coherence Tomography Angiography

“…All the subjects were examined by SS-OCTA (SS-OCTA, VG200D, SVision Imaging, Ltd., China) (18), with the scanning mode 3 × 3 mm for FAZ measurement and to obtain the fundus images with the central area of 3 × 3 mm around the fovea of the macula. The data of 12 × 12 mm area centered on the fovea were obtained with 1,024 × 1,024 B-scans, 12 × 12 mm SS-OCTA images were captured with the commercial VG200 SS-OCTA device (19).…”

Posterior scleral reinforcement for the treatment of myopic traction maculopathy

“…Zhang et al [ 38 ] found that both superficial and deep retinal blood flow density and blood flow index in the macular increased after PSR. Zhang et al [ 39 ] found that choroidal thickness and choroidal blood flow increased significantly after PSR in one week. Therefore, we might hypothesize that, due to the stimulating effect of the allograft sclera, neovascularization develops in the sclera, and the blood supply to the corresponding parts of the retina and choroid is improved, promoting metabolism in the optic cells, however, it remains to be proven.…”