| High myopia, also known as pathological myopia, is myopia with more than 6.0 diopters (D). Continuous lengthening of optic axis in high myopia leads to increasing of myopia, which can cause irreversible damage to visual acuity because of vitreous degeneration, posterior scleral staphyloma formation and detachment of retina. There is about 2% of high myopia in myopia all over the world; and the ratio is much higher in teenagers. Treatment is aimed at effectively controlling growth of optic axis and preventing complications. In the study, we investigated timing of treatment and its effect to high myopia, especially in teenagers, by posterior scleral reinforcement combined with traditional Chinese medicine (TCM).Part 1 review1. High myopia in TCMIn TCM, high myopia means "can see things at close distance but not in far places", "it is unclear to see things in far places". There are many interpretations of the cause, but the main interpretation dues it to heart, spleen and kidney, reinforcing deficiency is the main treating principle.2. High myopia in western medicineEpidemiology, etiology and treatment of high myopia are discussed in references.3. Posterior scleral reinforcement to high myopia History of posterior scleral reinforcement, choice of reinforcement material and development of the treatment are discussed in the article after we summarized references at home and abroad.Part 2 Clinical research Objective: optic axis, eyesight, corrected vision as indicators, we observe and evaluate timing of treatment and its effect to high myopia, especially in teenagers, by posterior scleral reinforcement combined with TCM.Methods: there were 92 patients with high myopia in the study, including 49 males and 43 females, mean age was 15 years old (range: 3-56), diopter from-1.75D to -37.00D.There were 41 teenagers with high myopia (73 eyes), including 14 females (24 eyes) and 27 males (49 eyes). Mean age was 10 years old (range: 3-33), diopter from -2.75D to -37.00D. They were randomly divided into two groups: posterior scleral reinforcement (21 patients with 39 eyes) and posterior scleral reinforcement combined with TCM (20 patients with 34 eyes), TCM was taken from 1 week before operation to 3 months after operation. Diopter, corrected vision, fundus change and optic axis were observed before and 1 year after operation.There were 10 patients received single eye operation, including 5 males and 5 females, mean age was 12.2 years old (range: 4-30), diopter from -1.75D to-26.25D. Diopter of both eyes was observed before and 1 year after operation.Optic axis was observed before and 1 week after operation in 33 patients (64 eyes), including 14 males (27 eyes) and 19 females (37 eyes). Mean age was 17 years old (range: 6-56).Diopter was observed before and 1 week after operation in 18 patients (35 eyes), including 8 males (15 eyes) and 10 females (20 eyes). Mean age was 21 years old (range: 9-45). Diopter was from -4.75D to -28.75D.Results: 1. Diopter decreased after operation than before both in male and female patients, but there was no statistic difference (P＞0.05); diopter was lower in male patients than in female ones after operation, but there was no statistic difference (P＞0.05); 2. After operation, optic axis increased in male patients and decreased in female ones than before, but there was no statistic difference (P＞0.05); there was no statistic difference (P＞0.05) of optic axis between male patients and female ones after operation; 3. Patients receiving posterior scleral reinforcement combined with TCM were divided into 4 groups according to different optic axes. Except diopter more than 30mm decreased 4 years after operation, diopter in the other three groups increased than before, but there was no statistic difference (P＞0.05); 4. Diopter in single eye operation decreased 1 year after operation than before, but there was no statistic difference (P＞0.05); diopter in normal eye increased significantly 1 year later, there was statistic difference (P＜0.05); 5. Diopter in patients receiving posterior scleral reinforcement increased 2 years after operation, there was statistic difference (P＜0.05); diopter in patients receiving posterior scleral reinforcement combined with TCM increased 2 years after operation, but there was no statistic difference (P＞0.05); there was statistic difference (P＜0.05) between the two groups 2 years after operation; 6. Diopter in patients receiving posterior scleral reinforcement combined with TCM increased in both teenagers and adults, but there was no statistic difference (P＞0.05); 2 years after operation, diopter in teenagers was higher than in adults, there was statistic difference (P＜0.05); 7. Diopter in teenagers receiving posterior scleral reinforcement increased 2 years after operation, but there was no statistic difference (P＞0.05); diopter in adults receiving posterior scleral reinforcement increased 2 years after operation, there was statistic difference (P＜0.05); 8. Diopter in teenagers receiving posterior scleral reinforcement increased 4 years after operation, there was statistic difference (P＜0.05); 9. Diopter in teenagers receiving posterior scleral reinforcement combined with TCM increased 5 years after operation, there was statistic difference (P＜0.05).Conclusions: posterior scleral reinforcement can significantly inhibit the increase of diopter in teenagers will high myopia, and combined with TCM will be better. Children less than 10 years old response the best to posterior scleral reinforcement combined with TCM.
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