Scleral Reinforcement Research Articles

Vitrectomy combined with posterior scleral reinforcement for high myopic macular retinoschisis

Objective To investigate the clinical efficacy of vitrectomy combined with internal limiting membrane peeling and posterior scleral reinforcement for the treatment of high myopic macular retionschisis. Methods The data of 37 eyes of 37 patients with high myopia and macular splitting who were treated in our hospital from Mar. 2014 to Feb. 2017 were analyzed retrospectively. All patients were treated with posterior scleral reinforcement combined with vitrectomy, internal limiting membrane peeling and intravitreal injection of air. Among them partial cataract patients were treated with phacoemulsification and intraocular lens implantation. The follow-up time was 12 months. Results After operation, the retinoschisis was completely closed in 37 eyes. The thickness of central macular retina at 3 months after operation was significantly lower than that before operation (P<0.05). The best corrected visual acuity at 6 months postoperatively was significantly higher than preoperatively(P<0.05), and the visual acuity at 12 months after operation was higher than that at 6 months after operation (P<0.05). The axial length at 6 months after operation was significantly shorter than that preoperatively(P<0.05), and the axial length at 12 months after operation was shorter than that at 6 months after operation (P<0.01). Transient high intraocular pressure occurred in 2 eyes. No secondary surgery treated or other complication occurred. Conclusion The clinical efficacy of posterior scleral reinforcement combined with vitrectomy and internal limiting membrane peeling for the treatment of high myopic macular retionschisis is good. Key words: Reinforcement, posterior sclera; Retinopathy; Myopia, high; Splitting, macula

Macular retinal thickness and flow density change by optical coherence tomography angiography after posterior scleral reinforcement

Optical coherence tomography angiography (Angio-OCT) has introduced a new non-invasive, quantitative method to assess superficial and deep capillary networks of the retina. In this study, we investigated macular retinal thickness and flow density change following posterior scleral reinforcement (PSR) surgery, using an RTVue XR Avanti Angio-OCT (A2016.2.0.35, Optovue, Fremont, CA), in patients with pathological myopia. A total of 13 patients with pathological myopia were recruited and all patients completed the 6 months follow-up visit. Data from 22 eyes were used in this study. The mean age was 36.23±15.29 years, and 43% (n=6) were men. Spherical equivalent refractive error (SE) ranged from -8.0 to -24.0 D. Post-operative axial length, best-corrected visual acuity and SE did not change significantly at each follow-up, compared with preoperative measure (all P>0.05). Postoperative flow density of superficial and deep retinal layers at each sector did not change significantly at each follow-up, compared to pre-operative measure (all P>0.05). However, we found significant decrease in retinal thickness of parafovea-inferior sector after PSR surgery (P<0.01), indicating potential relaxation of vitreofoveal traction after PSR surgery.

Modified Posterior Scleral Reinforcement as a Treatment for High Myopia in Children and Its Therapeutic Effect.

Purpose To investigate the safety and therapeutic effect of a modified posterior scleral reinforcement (PSR) in treating high myopia. Methods A total of 85 highly myopic eyes in 47 children (6.3±3.6 years of age, range from 3 years to 15 years) who underwent this modified PSR were included in this study. Axial length, refractive error, best-corrected visual acuity (BCVA), macular scans, and adverse events were recorded before the operation (as a baseline) and in postoperative reviews taken yearly for 5 years. Results This was a 5-year research: 50% of the children (20 children, 40 eyes) participated in the 6-month review, 41% of the children (17 children, 33 eyes) participated in the 1-year review, 26% of the children (11 children, 21 eyes) participated in the 2-year review, 16% of the children (7 children, 13 eyes) participated in the 3-year review, 13% of the children (5.3 children, 11 eyes) participated in the 4-year review, and 8% of the children (3.3 children, 7 eyes) participated in the 5-year review. Compared with the baseline, axial elongation was significantly changed (P<0.05) over the 5-year period in all of the children: 6-month (P=0.003), 1-year (P=0), 2-year (P=0), 3-year (P=0), 4-year (P=0), and 5-year (P=0). The axial length was extended. No significant difference was found in refractive error between measurements taken at baseline and at the 5-year postoperative visit in all of the children: 6-month (P=0.51), 1-year (P=0.50), 2-year (P=0.46), 3-year (P=0.56), 4-year (P=0.30), and 5-year (P=0.16). There were significant differences in BCVA between measurements taken at baseline and at the postoperative 5-year visit in all the children: 6-month (P=0), 1-year (P=0), 2-year (P=0), 3-year (P=0), 4-year (P=0), and 5-year (P=0). BCVA improved in 71 eyes (83.52%), remained stable in 14 eyes (16.47%), and declined in none of the children. No serious adverse events occurred before the operation and during the 5-year follow-up period. Conclusion This modified PSR could be a therapeutic treatment for high myopia.

Effects of posterior scleral reinforcement in pathological myopia: a 3-year follow-up study.

To assess the effects of posterior sclera reinforcement (PSR) in refractive outcomes, choroidal thickness (CT), and retinal thickness (RT) during a 3-year follow-up in eyes with pathological myopia. Thirty-eight eyes of 26 adults with pathological myopia who underwent PSR (the PSR group) and 30 eyes of 18 adults with matched age and myopia who did not receive PSR treatment (the control group) were followed up with measurements of axial length (AL), spherical equivalent (SE), best corrected visual acuity (BCVA), CT, and RT at baseline, 1 and 3months, and 1, 2, and 3years postoperatively. Data were analyzed by repeated measures analysis of variance and independent-samples t test. In the PSR group, AL, SE, BCVA, and CT were tending to be relatively stable and no statistically significant changes were found during the follow-up (all P > 0.05). In contrast, in the control group, compared with the measurements taken at baseline, AL, SE, BCVA, and CT altered gradually from 1month onward to 3years postoperatively. At 2-year and 3-year follow-ups, significant differences in AL, SE, BCVA, and CT were noted between the PSR group and the control group (all P < 0.05). RTs of the center subfield and the inner ring were equal to the baseline in the control group; however, RTs of the center subfield at 1year, 2years, and 3years postoperatively significantly slightly reduced compared with those at the baseline in the PSR group (all P < 0.05). The effects of PSR in restraining eyeball elongation, stabilizing vision, and strengthening the structure of posterior pole are more prominent 2years or more postoperatively compared with the natural progression of pathological myopia.

Posterior staphyloma in pathologic myopia.

A posterior staphyloma is an outpouching of a circumscribed region of the posterior fundus and has been considered a hallmark of pathologic myopia. Occurring in highly myopic eyes, it is histologically characterized by a relatively abrupt scleral thinning starting at the staphyloma edge, a pronounced de-arrangement of scleral collagen fibrils and a marked choroidal thinning, which is the most marked at the staphyloma edge and which occurs in addition to the axial elongation-associated choroidal thinning. Besides in highly myopic eyes, a posterior staphyloma can be found in non-highly myopic eyes in association with retinitis pigmentosa or localized defects of Bruch's membrane in the cases of which it is not associated with a marked choroidal thinning. The diagnosis of posterior staphylomas is considered best made by wide-field optical coherence tomography, because wide-field optical coherence tomography encompasses the entire extent of the most predominant type of staphylomas (i.e., the wide macular type) and since it also has a sufficiently high resolution of images (in contrast to ultrasonography, computed tomography and three-dimensional magnetic resonance imaging). While the etiology of posterior staphylomas has remained unclear, local choroidal factors and a locally decreased biomechanical resistance of the sclera against a posteriorly expanding Bruch's membrane have been one of the assumed pathogenic parameters. For the therapy of staphylomas, scleral reinforcement strategies such as by posterior encircling bands, posterior scleral collagen cross-linking or scleral regeneration have been discussed or performed, however, with the pathogenesis being elusive, the therapy of staphylomas has remained undetermined.

Posterior scleral reinforcement using genipin-cross-linked sclera for macular hole retinal detachment in highly myopic eyes

Background/aimsTo investigate the surgical outcomes of posterior scleral reinforcement (PSR) using genipin-cross-linked sclera to treat macular hole retinal detachment (MHRD) in highly myopic eyes.MethodsNineteen patients with high myopia (19 eyes)...

Axial Length/Corneal Radius of Curvature Ratio Assessment of Posterior Sclera Reinforcement for Pathologic Myopia

Purpose: The aim of this study was to assess the axial length/corneal radius of curvature ratio changes after posterior scleral reinforcement (PSR) for pathologic myopia. Procedures: This study enrolled 32 pathologically myopic eyes treated with PSR and 35 untreated pathologically myopic eyes. Axial length, refractive error, best corrected visual acuity, corneal radius of curvature, and the axial length/corneal radius of curvature ratio were evaluated during the 1-year follow-up. Results: There were no statistical differences in each parameter between the 2 groups at baseline. Significant differences were found between the 2 groups in both axial elongation and best corrected visual acuity improvement. The average axial length/horizontal corneal radius of curvature ratio significantly decreased in the PSR group. Conclusion: The PSR surgery can effectively delay the axial elongation in pathological myopia. Axial length/horizontal corneal radius of curvature ratio significantly decreased, which may indicate less myopic progression after surgery.

Long-term efficacy of posterior scleral reinforcement for maculoschisis in high myopia

Objective To evaluate long-term efficacy of posterior scleral reinforcement for the treatment of maculoschisis in high myopic eyes. Methods The data of 37 eyes of 30 cases with maculoschisis in high myopia eyes were collected and analyzed retrospectively, they underwent scleral reinforcement with allodural or allogeneic sclera, and the followed-up time was 5 years. Results After surgery, all cases were examined with optical coherence tomography(OCT). The splitting cavity of retina disappeared in 33 eyes(89.2%). The splitting wasn’t improved in 2 eyes. The macular hole occurred in 2 eyes. After surgery, the refractive degree was lower, and the difference was statistically significant(χ2=47.910, P=0.000). The best corrected visual acuity (BCVA) were improved after surgery, and the difference was statistically significant(t=5.034, P=0.011). The mean length of the ocular axis in patients before surgery was (29.42±2.67) mm. After 6 months, 1, 3 and 5 years, the length of axis were respectively: (28.21±1.87)mm, (28.63±1.62)mm, (29.16±2.15)mm and (29.31±2.42)mm. Conclusion Posterior scleral reinforcement surgery in the treatment of high myopia and maculoschisis is effective , it can stable eye axis and improve visual acuity. Key words: Maculoschisis, high myopia; Posterior scleral reinforcement; Efficacy, long-term

The application of three-dimensional printing technology of MRI in posterior sclera reinforcement surgery for high myopia

Objective To investigate the application value of three-dimensional (3D) printing technology of MRI in posterior sclera reinforcement surgery for high myopia. Methods The data of 29 eyes of 30 patients with high myopia were collected and they underwent posterior sclera reinforcement ( PSR ). All cases received 3D MRI before and after PSR. The MRI data of patients were reconstructed by using materialise’s interactive medical image control system software to generate stereo lithography ( STL ) file, then STL file was turned into print recognizable path file by printing program software, and finally 3D eyeball, ocular muscles, optic nerve and PSR strip model were printed proportionally by using 3D printers. Results According to MRI image data, 3D solid individualized proportional model of eyeball, ocular muscles, optic nerve and PSR strip were successfully printed. Conclusion Three-dimensional proportional model of eyeball, ocular muscles, optic nerve and PSR strip made by 3D printers are contribute to preoperative and postoperative PSR with the certain value in application. Key words: Three-dimensional (3D) printing technology; Myopia, high; Reinforcement, posterior sclera; Application value

Using High-Resolution 3D Magnetic Resonance Imaging to Quantitatively Analyze the Shape of Eyeballs with High Myopia and Provide Assistance for Posterior Scleral Reinforcement

Purpose: To quantitatively analyze the shape of eyes with high myopia and provide assistance for posterior scleral reinforcement (PSR) using high-resolution three-dimensional (3D) magnetic resonance imaging (MRI). Method: In all, 260 eyes of 134 patients with high myopia were assessed in this study; 120 emmetropic volunteers were enrolled as a control group. The subjects were examined using 3D T2-weighted CUBE sequences. Results: The eyeballs' axial, horizontal, and vertical lengths were longer and their volume was larger in the subjects with high myopia than in those with emmetropia. The sites of the four recti and optic nerve attachment to the eye were clearly seen on 3D MRI, and the geometric information could be quantified for PSR preparation. The scleral strip was revealed by 3D MRI after surgery. Conclusions: 3D MRI can quantitatively analyze the shape of eyes with high myopia. 3D MRI examination might be necessary before and after PSR for preoperative preparation and postoperative assessment.

The application of three-dimensional MRI for posterior sclera reinforcement of patients with high myopia

Objective To observe the application and function of three-dimensional magnetic resonance imaging (3-D MRI) for posterior sclera reinforcement (PSR) of patients with high myopia. Methods Twenty eyes of 19 cases with high myopia underwent PSR. All cases took 3-D MRI before and after surgery. Before surgery, the arc length from upper corneal limbus through the peak of the scleral staphyloma to under corneal limbus, horizontal and vertical arc length of the staphyloma, and arc length from temporal border of the staphyloma to optical nerve were measured. In postoperative PSR, the image of strip was reconstructed. Results The three dimensional measured value related to the staphyloma was obtained by 3-D MRI. PSR strip showed clear. Among all cases, the strips just reinforcement in the staphyloma were 14 eyes. Six eyes occurred deviation from the staphyloma, including 5 eyes deviated to temporal side of the staphyloma and 1 eye closed to the optic nerve. After the second times of the PSR, the position of the strip was moderate. Conclusion The application of 3-D MRI contributes to preoperative assessment and postoperative evaluation, it has the certain value in clinical application. Key words: Myopia, high; Staphyloma, scleral, posterior; Posterior sclera reinforcement; MRI, three-dimensional

A preliminary study on macular retinal and choroidal thickness and blood flow change after posterior scleral reinforcement by optical coherence tomography angiography

Objective: To investigate macular retinal and choroidal thickness and blood flow change using optical coherence tomography angiography after posterior scleral reinforcement (PSR) surgery. Methods: Prospective study. Twenty eyes of 10 patients with high myopia were enrolled in this open-label, single-treatment group and prospective study. Radial lines and Angio retina (3 mm×3 mm) module were performed for 20 eyes using Angio-vue optical coherence tomography (Avanti, Optovue) without pupil dilation, and best corrected visual acuity, spherical equivalent and axial length were compared before and 60 days after surgery. Retinal and choroidal thickness was measured in the fovea, 1 mm superior, 1 mm inferior, 1 mm nasal and 1 mm temporal to the fovea. Flow area, flow density and flow index were recorded using self-provided software in the superficial retina layer, deep retina layer, outer retina layer and choroid capillary layer, respectively. Statistical analysis was performed using SPSS 16.0. Data that followed normal distribution were compared with paired two-sample t-test, while others were compared with Wilcoxon signed rank test. Results: Of the patients participating in this preliminary study, the mean age was (35.5±4.2) years, and 50% were female. No significant difference was found between before and 60 days after PSR surgery in best corrected visual acuity (t=0.99, P=0.33), spherical equivalent (t=-1.89, P=0.07) and axial length (t=0.2, P=0.08). The retinal thickness in the fovea was thinner (Z=-2.58, P=0.01), while there was no significant difference in the 1 mm superior (t=0.44, P=0.67) , 1 mm inferior (t=0.05, P=0.96) , 1 mm nasal (Z=0.87, P=0.64) and 1 mm temporal (Z=-0.78, P=0.99) to the fovea. No significant difference was found in choroidal thickness (t=-0.12, P=0.87; t=-0.25, P=0.81. t=0.53, P=0.61; t=-0.91, P=0.38. t=1.2, P=0.25) before and after surgery. The postoperative flow density in the superficial and deep retinal layers (48.18±4.56% and 31.47±5.11%) was significantly increased (t=2.66, P=0.02; t=3.16, P=0.01) compared with pre-operation (33.82±4.33% and 14.29±3.89%). The postoperative flow index in the superficial and deep retina layers (0.044±0.005 and 0.025±0.005) was significantly increased (t=2.59, P=0.02. t=2.95, P=0.01) compared with pre-operation (0.028±0.004 and 0.010±0.003). The other flow measurements showed no significant difference. Conclusion: Retinal thickness decreased, and flow density and index increased in the superficial and deep retinal layers after PSR surgery. This suggested blood flow improvement in the macular region after PSR surgery in high myopic eyes. (Chin J Ophthalmol, 2017, 53:39-45).

Application of optical coherence tomography angiography in assessment of posterior scleral reinforcement for pathologic myopia.

To investigate the effect of posterior scleral reinforcement (PSR) on circulation of pathologic myopia eyes with posterior staphyloma by optical coherence tomography angiography (OCTA). The study included 30 pathologic myopia eyes with posterior staphyloma which underwent PSR (PSR group) for 6 to 18mo ago, and 30 age and myopia matched eyes without PSR surgery as control group. Macular, choriocapillaris and radial peripapillary capillary (RPC) flow density were measured by OCTA, and the measurements were compared between groups. OCTA found no significant differences in macular flow density between PSR and control groups. For the superficial flow, whole enface flow density (WED), fovea density (FD), and parafoveal density (PD) were 46.55%±5.19% vs 47.29%±4.12% (P=0.542), 31.45%±6.35% vs 31.17%±4.48% (P=0.841), and 48.82%±5.66% vs 49.21%±4.15% (P=0.756) in PSR and control groups, respectively. For the deep flow, WED, FD, and PD were 52.07%±5.78% vs 53.95%±4.62% (P=0.168), 29.62%±6.55% vs 29.50%±6.38% (P=0.940), and 56.93%±6.17% vs 58.15%±5.13% (P=0.407) in PSR and control groups, respectively. The choriocapillary flow density was 61.18±3.25% in PSR group vs 60.88%±2.56% in control group (P=0.692). Also, OCTA found no significant differences in RPCs flow density between PSR and control groups. The optic disc WED, inside disc flow density and peripapillary flow density were 48.47%±4.77% vs 48.11%±4.57% (P=0.813), 45.47%±11.44% vs 46.68%±9.02% (P=0.709), 54.32%±5.29% vs 52.47%±6.62% (P=0.349) in PSR and control groups, respectively. OCTA provides a non-invasive and quantitative approach for monitoring macular and papillary blood flow in pathologic myopia. PSR can not improve but may maintain the circulation of pathologic myopia eyes with posterior staphyloma.

Results of microinvasive cross‐linking of rabbit posterior eye pole sclera

PurposeTo evaluate the results of scleral crosslinking (SXL) with ultraviolet‐A (UVA) radiation and riboflavin in the equator and the posterior pole of the eye using a minimally invasive techniqueMethodsThe tool includes a UV‐LED source (370 nm, 3 mW/cm²) guided through optic fiber located in one of the two channels of a detachable tip. The other channel is used to deliver riboflavin to the scleral surface through a small conjunctival incision, sutured after SXL. It was performed in vivo on 8 rabbit eyes. Intact fellow eyes served as control. Scleral echodensity was measured in vivo with Voluson 730Pro prior to, 2 days and 1 month after the procedure. The biomechanical characteristics of the sclera of enucleated eyes were measured 3 days and 1 month after the procedure with Autograph (Shimadzu). Collagen crosslinking level was measured at the same times using Differential Scanning Calorimetry with Phoenix DSC20144 (Netzsch).ResultsAs a result of the procedure, scleral echodensity (median) increased from 86.7 to 98 dB after 2 days, and to 103 dB after 1 month. The control group revealed no change in the corresponding values. Elasticity modulus (E) of the treated zone was 25.4 MPa after 3 days, while in the control group E was 16.7 MPa. 1 month after, the value of E showed no significant change. Collagen cross‐linking level in the experimental group exceeded that of the control group by 15–18%.ConclusionsThe proposed tool ensures minimally invasive UVA crosslinking of the equatorial and the posterior parts of the sclera and ensures an increase of its biomechanical stability. It opens good prospects for sclera reinforcement treatment of progressive myopia.This work was supported by the Russian Foundation of Basic Research (grant No 15‐29‐03874).

Posterior scleral reinforcement for the treatment of pathological myopia.

To investigate the effects of posterior scleral reinforcement (PSR) in the treatment of pathological myopia. The study included 52 eyes in 43 patients with pathological myopia who underwent PSR (PSR group), and 52 eyes in 36 age- and myopia-matched patients who did not undergo such treatment as control group. Axial length, refraction error, best corrected visual acuity (BCVA), and macular scans by optical coherence tomography (OCT) were recorded at baseline, 6mo, 1, 3 and 5y after the surgery, and the complications were noted. There were no statistical differences in axial length, refractive error, or BCVA between the PSR group and the control group at baseline. At the end of the follow-up, the mean axial length was 29.79±1.26 mm in the PSR group, which was significantly shorter than that in the control group (30.78±1.30 mm) (P<0.01), and the mean refractive error was -16.86±2.53 D in the PSR group, which was significantly lower than that in the control group (-19.18±2.12 D) (P<0.01). A statistically significant difference in BCVA was found between the PSR group (0.51±0.25 logMAR) and the control group (0.62±0.26 logMAR) at the postoperative 5-year follow-up (P<0.01). There were no serious complications during the 5-year follow-up period. PSR can prevent axial elongation and myopia progression in eyes with pathological myopia.

The efficacy and safety of posterior scleral reinforcement using genipin cross-linked sclera for macular detachment and retinoschisis in highly myopic eyes

Background/aimsTo evaluate the efficacy and safety of posterior scleral reinforcement (PSR) using genipin cross-linked sclera as the material to treat macular detachment and retinoschisis, both without macular hole, in highly...

Posterior scleral reinforcement combined with vitrectomy for myopic foveoschisis.

To investigate the effects of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis. Thirty-nine highly myopic eyes of 39 patients with myopic foveoschisis underwent PSR combined with vitrectomy. Best corrected visual acuity (BCVA), refraction error, and the foveal thickness by optical coherence tomography (OCT) were recorded before and after the surgery, and complications were noted. The follow-up period was 12mo, and the main focus was on the results of the 12-month follow-up visit. The mean preoperative BCVA was 0.96±0.43 logMAR. At the final follow-up visit, the mean BCVA was 0.46±0.28 logMAR, which significantly improved compared with the preoperative one (P=0.003). The BCVA improved in 33 eyes (84.62%), and unchanged in 6 eyes (15.38%). At the end of follow-up, the mean refractive error was -15.13±2.55 D, and the improvement was significantly compared with the preoperative one (-17.53±4.51 D) (P=0.002). Twelve months after surgery, OCT showed complete resolution of the myopic foveoschisis and a reat-tachment of the fovea in 37 eyes (94.87%) and partial resolution in the remained two eyes (5.13%). The foveal thickness was obviously reduced at 12-month follow-up visit (196.45±36.35 µm) compared with the preoperative one (389.32±75.56 µm) (P=0.002). There were no serious complications during the 12mo follow-up period. PSR combined with vitrectomy is a safe and effective procedure for myopic foveoschisis with both visual and anatomic improvement.

The efficacy and safety of a novel posterior scleral reinforcement device in rabbits

PurposeTo evaluate the efficacy and safety of posterior scleral reinforcement (PSR) device for myopia suppression in rabbits' eyes. MethodsPSR surgery was performed on the normal 12 8-week-old New Zealand white rabbits' right eyes. To determine efficacy of the device, ophthalmic examination would be taken at pre-operation and post-operation (1week, 1month, 3months, 6months, and 1year), such as A-ultrasound, diopter and B-ultrasound. Evaluation of safety were based on the following indicators: intraocular pressure (IOP), slit lamp, fundus photography, fundus fluorescein angiography and pathological examination after surgery. The efficacy and safety of PSR device were evaluated by comparison (treated eyes and contralateral eyes) of pre and post-operation. ResultsThe novel PSR device could significantly shorten axial length (preoperative axial length: 16.36±0.14mm, postoperative 1week, 1month, 3months, 6months and 1year axial lengths: 15.03±0.28mm, 15.23±0.32mm, 15.39±0.31mm, 15.45±0.22mm and 15.45±0.22mm; P=0.00037<0.001) in the treated eyes (right eyes) after surgery. At different postoperative time points, the B-ultrasound images showed that the PSR located in appropriate position and supported the posterior sclera very well. At the same time, IOP of treated eyes kept a relatively stable level (preoperative IOP: 12.56±2.01mmHg, postoperative IOP: ranging from 11.33±1.23mmHg to 13.44±2.19mmHg, P>0.05) post-operation 1year. During observation period, there was no significant inflammatory reaction and complications such as anterior chamber flare, empyema, endophthalmitis, vitreous hemorrhage, retina detachment and retinal choroid neovascularization by slit lamp, fundus photography and fundus fluorescein angiography. In addition, there were no pathologic changes be found by comparison treated eyes group and contralateral group eyes based on pathological examinations. ConclusionsIn vivo study, effectively and safely, the novel PSR device can inhibit rabbits' axial length elongation during postoperative 1year. This study demonstrates that this novel PSR could be a potential treatment approach for myopia.

儿童后巩膜加固术的家长依从性研究

目的：探讨儿童病理性近视行后巩膜加固术的适应症及家长依从性。方法：随访2015年4月至2016年4月我院门诊确诊病理性近视的患儿及家长，并分析影响入院行后巩膜加固术家长依从性的因素。结果：我院门诊确诊病理性近视眼的18岁以下青少年儿童120名，介绍手术，结果仅23人(19.17%)同意行手术治疗。影响家长依从性的因素主要包括患儿年龄、家庭条件、家长知识水平、态度及信念、治疗方案及其他外部因素。结论：儿童病理性近视的手术时机选择很关键，对于适应症患儿，医护人员应通过建立互相信任的沟通体系增强家长依从性。 Objective: To discuss the indication and parental compliance of children posterior scleral rein-forcement. Methods: Children who were diagnosed as pathologic myopia at our out-patient clinics between April 2015 and April 2016 were investigated and followed with their parents. Factors in-fluencing the parental compliance of posterior scleral reinforcement were analyzed. Results: A total of 120 children under 18 years old were diagnosed as pathologic myopia at our out-patient clinics during the study period; however, only 23 children (19.17%) agreed to receive the surgery. Factors influencing parental compliance mainly include age of the children, familial conditions, parental education level, attitude and belief toward the disease, therapeutic schedule and other external factors. Conclusion: Timing for the surgery of children pathologic myopia is crucial; therefore, for surgery requiring children, medical personnel should strengthen the parental compliance by establishing a trustful and effective communication system between the two parties.

Efficacy of pterygium reversal tear-cutting, conjunctival autograft and sclera reinforcement fixation

Efficacy of pterygium reversal tear-cutting, conjunctival autograft and sclera reinforcement fixation