The efficacy and safety of posterior pole buckles in the control of progressive high myopia

Abstract

Purpose Degenerative myopia is a significant cause of vision loss; yet there is no accepted way of controlling its causative phenotypeFprogressive high axial myopia. Scleral reinforcement, introduced over 50 years ago, was discredited as a useful technique. This 5-year 'proof of concept' study examines buckling of the posterior pole for myopia control and follows the course of untreated fellow eyes. Method A total of 59 adult eyes, with myopic refractive corrections ranging from À9 to À22 D and axial lengths from 27.8 to 34.6 mm, were studied. A 1-cm-wide flexible buckle of donor sclera was positioned over the posterior pole and secured, under positive tension, to the anterior globe. The eyes were monitored for 5 years, as were unsupported fellow eyes. The axial lengths, visual acuities, and optical coherence tomography macular scans were collected and all complications were noted. Results Over 5 years, axial length control was achieved by scleral buckling, whereas axial extension progressed in the untreated group. No serious complication occurred and no eye lost visual acuity from the procedure. Temporary intra-ocular pressure elevation, small choroidal effusions, and variable periods of abduction limitation occurred after surgery. In one case of tractional myopic macular schisis, a full correction was achieved by buckling and visual acuity improved.

Genipin-Crosslinked Donor Sclera for Posterior Scleral Contraction/Reinforcement to Fight Progressive Myopia

“…Myopic maculopathy usually develops during one's 50th to 60th year of life. 2 In the study by Ward et al, 49 all the adult high myopia patients had some degree of myopic macular degeneration. 49 There are very few studies like the current study in the literature.…”

“…2 In the study by Ward et al, 49 all the adult high myopia patients had some degree of myopic macular degeneration. 49 There are very few studies like the current study in the literature. A modified Snyder-Thompson posterior scleral reinforcement surgery was investigated in highly myopic Chinese children, but that study was retrospective and not self controlled, with homologous dura mater as the enforcement material.…”

“…33,48 A similar surgery, posterior buckling, has also been used to control myopic progression in adult patients and has been shown to effectively control axial length expansion during 4 to 5 years of follow-up. 49 The current study was conducted on young patients with a mean age of 10.05 6 4.23 years. Eyes in this period of life grow much faster than in adulthood and are therefore difficult to control.…”

Posterior sclera reinforcement and phakic intraocular lens implantation for highly myopic amblyopia in children: a 3-year follow-up

“…These lesions may ultimately lead to a serious decline in visual acuity. Many researches 8,10,11 indicate that reinforcement of the posterior sclera can allow the allogeneic scleral material place around the macular area to adhere to the host sclera, and promote the entry of new vessels, thicken the new sclera, and mechanical reinforcement of the wall of eyeball. These changes can alleviate the pressure that extends back into the eye and maintain a stable refractive statue.…”

Scleral Reinforcement Through Host Tissue Integration with Biomimetic Enzymatically Degradable Semi-Interpenetrating Polymer Network

“…20,22 These options have yet to gain wide clinical acceptance because of high toxicity (e.g., glutaraldehyde), lack of complete understanding of the mechanism of action (methylxanthines), limited access to clinical trial data (polyvinylpyrrolidone injections), and for scleroplasty, limited supply of allograft material, its invasive nature, and limited data supporting its long-term efficacy. 23 As an alternative, a minimally invasive scleral reinforcement strategy that takes advantage of the biochemical properties of host sclera was developed. We have begun testing injectable and highly tunable biomimetic hydrogels based on poly(N-isopropylacrylamide).…”