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.
Highlights
The rapidly increasing prevalence of myopia poses one of the most serious public health issues, especially in Asia where pathological myopia has been reported as the primary cause of blindness or low vision in 12–27% of the populations [1,2,3]
Twenty-four patients with 25 eyes diagnosed with pathological myopia were recruited and completed 1 week and 1 month postoperative follow-ups
MMD severity was significantly correlated with axial length (AL), spherical equivalent (SE) (r = −0.87, P < 0.001), and best corrected visual acuity (BCVA) (r = 0.49, P = 0.02)
Summary
The rapidly increasing prevalence of myopia poses one of the most serious public health issues, especially in Asia where pathological myopia has been reported as the primary cause of blindness or low vision in 12–27% of the populations [1,2,3]. The major alterations in pathologic myopia include excessive axial elongation of the globe and associated local ectasia of the posterior sclera, which eventually leads to characterized retinal and choroidal lesions as well as impacts on macular function [4, 5]. Laid between the retina and the sclera in the posterior eye, the highly vascular choroid is essential for maintaining the normal physiology of the eye, such as supplying oxygen and nutrients for the outer retina. There is substantial evidence that the choroid plays an important role in controlling ocular elongation and refractive error development [6, 7]. Controlling choroidal thinning could be a crucial approach to maintain emmetropia and reduce the incidence of severe myopic maculopathy
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