Abstract
BackgroundHigh myopia is a sight-threatening disease that causes axial length elongation and severe complications. Data on the benefits of posterior scleral reinforcement surgery in myopia control have been conflicting. The purpose of this study was to explore the treatment effect and complications of posterior scleral reinforcement in the treatment of myopia.MethodsArticles were retrieved for relevant studies from inception to July 24, 2019, by PubMed, EMBASE, and Ovid. Analyses were conducted to compare the treatment effects of controlling spherical equivalent refraction and axial length elongation. The weighted mean difference and Hedges’ adjusted g were used to evaluate the treatment effects, with a random-effects model. Heterogeneity was quantified using I2 statistic and explored by subgroup analysis. Publication bias was addressed by funnel plots and Egger’s test.ResultsA total of 11 articles were included in this meta-analysis. On estimating the treatment effect, the mean differences of myopia progression and axial length changes between surgery and control groups were 0.41 diopters per year (95% CI 0.21 to 0.61; P < .001) and −0.17 mm per year (95% CI −0.22 to −0.11; P < .001). Subgroup analysis showed significant treatment effects of the single wide strip operation. Single-arm meta-analysis showed less annual axial elongation in children subgroup. These results were robust by sensitivity analysis. The incidence of some major complications in the operation group were significantly greater (5.8% vs 2.7% for myopic degeneration; 2.3% vs 1.6% for macular hemorrhage; 0.8% vs 0 for retinal detachment).ConclusionPosterior scleral reinforcement may be an effective surgery on controlling myopia progression by slowing both refraction and axial length change. However, frequent surgical complications should be considered. Further well-designed studies are needed to determine the long-term safety and efficacy.
Highlights
Pathologic myopia is one of the major causes of blindness worldwide
On estimating the treatment effect, the mean differences of myopia progression and axial length changes between surgery and control groups were 0.41 diopters per year and −0.17 mm per year
[4] there was no cilioretinal artery occlusion noted in our review
Summary
Pathologic myopia is one of the major causes of blindness worldwide. It is an important and sight-threatening disease that causes scleral thinning, axial elongation, localized posterior scleral ectasia, [1] and eventually many severe complications such as retinal detachment, myopic choroidal neovascularization, macular schisis, and macular hole, and macular degeneration. [2] For controlling myopia progression, posterior scleral reinforcement (PSR) surgery was first described by Shevelev in 1930, and was modified as the Snyder-Thompson method in 1972, which is the most common performed operation currently. Pathologic myopia is one of the major causes of blindness worldwide It is an important and sight-threatening disease that causes scleral thinning, axial elongation, localized posterior scleral ectasia, [1] and eventually many severe complications such as retinal detachment, myopic choroidal neovascularization, macular schisis, and macular hole, and macular degeneration. [2] For controlling myopia progression, posterior scleral reinforcement (PSR) surgery was first described by Shevelev in 1930, and was modified as the Snyder-Thompson method in 1972, which is the most common performed operation currently. In 1961, Curtin described the X-type operation using a cruciate-shaped fascia lata graft extending from the four quadrants of eyeball. The purpose of this study was to explore the treatment effect and complications of posterior scleral reinforcement in the treatment of myopia
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