The Effectiveness And Safety Of Minimally Invasive Posterior Scleral Reinforcement In Children With High Myopia

Aims:To evaluate the effectiveness and safety of minimally invasive 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:A retrospective study.We retrospectively analyzed the preoperative and postoperative follow-up data of children with high myopia patients who underwent minimally invasive posterior scleral reinforcement surgery from August 2018 to August 2020 in Peking University People’s Hospital.Individuals who met the following criteria were included in this study:children aged between 3 and 18 years old,the myopic spherical equivalent(SE)was≥ 6.00 diopters(D)and the axial length(AL)was≥24 mm.The following patients were not included in this study:patients who had previously received myopia treatment other than wearing glasses;patients who had other eye diseases that affect visual function,such as cataracts,glaucoma,nystagmus,strabismus,ocular trauma,and retinal detachment;patients with non-axial myopia;patients who had undergone vitrectomy,scleral buckling and other surgical treatments;and patients with systemic diseases that may affect the results.Before and after operation,all patients underwent automatic refractometer examination under ciliary muscle anaesthesia,best corrected visual acuity(best corrected visual acuity,BCVA),slit lamp anterior segment examination,axial length examination,widefield fundus photography examination.These patients were followed up 3 months,6 months,1 year and 2 years postoperatively.The differences of BCVA,computer optometry and axial length before operation were calculated,and the fundus lesions were followed up.Pre-and post-operative examination results were collected and analyzed.The measurement data were expressed by mean±standard deviation.Paired t-test was used to compare the results before and after operation.There was significant difference when P<0.05.Results:The current analysis included 31 patients(53 eyes),21 males aged from 3 to 16 years old and 10 females aged from 4 to 10 years old.The average age of all the patients was 6.38±3.35 years and ranged from 3 to 16 years.Preoperatively,the diopter was-9.552±3.492D,the axial length was 26.16 ± 1.41mm and the BCVA was 0.40±0.45.The axial length of the eye increased by 0.07 mm(P=0.014),0.12 mm(P=0.005),0.31 mm(P<0.001)and 0.19 mm(P=0.063)at 3 months,6 months,1 year and 2 years after the operation,respectively.The refractive error increased by-0.05 D(P=0.358)、+0.28 D(P=0.198)、-0.53D(P=0.478)and-0.50D(P=0.312)at 3 months,6 months,1 year and 2 years after the operation,respectively,and the differences were not significant.The BCVA at 3 months,6 months,1 year and 2 years after BCVA were 0.37±0.32(P=0.365),0.26±0.31(P=0.298),0.30±0.30(P=0.561)and 0.11±0.15(P=0.604),respectively.There were no statistically significant changes in BCVA,but there was an upward trend.No severe complications occurred.Conclusions:Minimally invasive modified posterior scleral reinforcement can effectively delay the worsening of the axial length and refractive error,without severe complications in the short term,which can be an effective therapeutic strategy for children with high myopia.