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

  • Cheng Peng
  • Jun Xu
  • Xiangying Ding
  • Yuanyuan Lu
  • Jiao Zhang
  • Fang Wang
  • Jiaming Yu
  • Hongna Wang
  • Jinsong Zhang
Refractive Surgery



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 3 months, and 1, 2, and 3 years 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 1 month onward to 3 years 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 1 year, 2 years, and 3 years 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 2 years or more postoperatively compared with the natural progression of pathological myopia.


Pathological myopia Posterior scleral reinforcement Axial length Spherical equivalent Choroidal thickness Retinal thickness 



This study was funded by the National Natural Science Foundation of China (81700814, 81703185, and 81870644), the Shenyang Science and Technology Bureau (18-014-4-46), and the Foundation of Liaoning Province Education Administration (LK201641).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

417_2018_4212_Fig4_ESM.png (301 kb)
Fig. 1

Schema of above, below and back demonstration after the U-shaped sclera buckle inserting underneath the inferior oblique, inferior rectus and lateral rectus, wrapping around the posterior pole. The scleral buckle is sutured to the nasal side of the sclera near the attachments of the inferior rectus and the superior rectus. (PNG 300 kb)

417_2018_4212_MOESM1_ESM.tif (1.9 mb)
High Resolution Image (TIF 1910 kb)


  1. 1.
    Morgan IG, Ohno-Matsui K, Saw SM (2012) Myopia. Lancet 379(9827):1739–1748. CrossRefGoogle Scholar
  2. 2.
    Xu L, Wang YX, Li YB, Wang Y, Cui TT, Li JJ, Jonas JB (2006) Causes of blindness and visual impairment in urban and rural areas in Beijing - the Beijing eye study. Ophthalmology 113(7):1134–1141. CrossRefGoogle Scholar
  3. 3.
    Liang YB, Friedman DS, Wong TY, Zhan SY, Sun LP, Wang JJ, Duan XR, Yang XH, Wang FH, Zhou Q, Wang NL, Handan Eye Study G (2008) Prevalence and causes of low vision and blindness in a rural Chinese adult population: the Handan Eye Study. Ophthalmology 115(11):1965–1972. CrossRefGoogle Scholar
  4. 4.
    Liu HH, Xu L, Wang YX, Wang S, You QS, Jonas JB (2010) Prevalence and progression of myopic retinopathy in Chinese adults: the Beijing Eye Study. Ophthalmology 117(9):1763–1768. CrossRefGoogle Scholar
  5. 5.
    Tideman JWL, Snabel MCC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RWAM, Vingerling JR, Hofman A, Buitendijk GHS, Keunen JEE, Boon CJF, Geerards AJM, Luyten GPM, Verhoeven VJM, Klaver CCW (2016) Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol 134(12):1355–1363. CrossRefGoogle Scholar
  6. 6.
    Neelam K, Cheung CMG, Ohno-Matsui K, Lai TYY, Wong TY (2012) Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 31(5):495–525. CrossRefGoogle Scholar
  7. 7.
    Verhoeven VJ, Wong KT, Buitendijk GH, Hofman A, Vingerling JR, Klaver CC (2015) Visual consequences of refractive errors in the general population. Ophthalmology 122(1):101–109. CrossRefGoogle Scholar
  8. 8.
    Ohno-Matsui K, Kawasaki R, Jonas JB, Cheung CMG, Saw SM, Verhoeven VJM, Klaver CCW, Moriyama M, Shinohara K, Kawasaki Y, Yamazaki M, Meuer S, Ishibashi T, Yasuda M, Yamashita H, Sugano A, Wang JJ, Mitchell P, Wong TY, META M-APM (2015) International photographic classification and grading system for myopic maculopathy. Am J Ophthalmol 159(5):877–883. CrossRefGoogle Scholar
  9. 9.
    Verhoeven VJM, Snabel MCC, van Rijn GA, Buitendijk GHS, Vvong KT, Keunen JEE, Boon CJF, Geerards AJM, Luyten GPM, Klaver CCW (2016) Axial length and visual function in high myopia. Invest Ophthalmol Vis Sci 57(12)Google Scholar
  10. 10.
    Snyder AA, Thompson FB (1972) A simplified technique for surgical treatment of degenerative myopia. Am J Ophthalmol 74(2):273–277CrossRefGoogle Scholar
  11. 11.
    Thompson FB (1978) A simplified scleral reinforcement technique. Am J Ophthalmol 86(6):782–790CrossRefGoogle Scholar
  12. 12.
    Zhu SQ, Zheng LY, Pan AP, Yu AY, Wang QM, Xue AQ (2016) The efficacy and safety of posterior scleral reinforcement using genipin cross-linked sclera for macular detachment and retinoschisis in highly myopic eyes. Br J Ophthalmol 100(11):1470–1475. CrossRefGoogle Scholar
  13. 13.
    Zhu Z, Ji X, Zhang J, Ke G (2009) Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients. Clin Exp Ophthalmol 37(7):660–663. CrossRefGoogle Scholar
  14. 14.
    Chen Z, Xue F, Zhou J, Qu X, Zhou X (2016) Effects of orthokeratology on choroidal thickness and axial length. Optom Vis Sci 93(9):1064–1071. CrossRefGoogle Scholar
  15. 15.
    Li Z, Cui D, Hu Y, Ao S, Zeng J, Yang X (2017) Choroidal thickness and axial length changes in myopic children treated with orthokeratology. Cont Lens Anterior Eye 40(6):417–423. CrossRefGoogle Scholar
  16. 16.
    Zhang Z, Zhou Y, Xie Z, Chen T, Gu Y, Lu S, Wu Z (2016) The effect of topical atropine on the choroidal thickness of healthy children. Sci Rep 6:34936. CrossRefGoogle Scholar
  17. 17.
    Margolis R, Spaide RF (2009) A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol 147(5):811–815. CrossRefGoogle Scholar
  18. 18.
    Dhoot DS, Huo SY, Yuan A, Xu D, Srivistava S, Ehlers JP, Traboulsi E, Kaiser PK (2013) Evaluation of choroidal thickness in retinitis pigmentosa using enhanced depth imaging optical coherence tomography. Br J Ophthalmol 97(1):66–69. CrossRefGoogle Scholar
  19. 19.
    Shen ZM, Zhang ZY, Zhang LY, Li ZG, Chu RY (2015) Posterior scleral reinforcement combined with patching therapy for pre-school children with unilateral high myopia. Graefes Arch Clin Exp Ophthalmol 253(8):1391–1395. CrossRefGoogle Scholar
  20. 20.
    Xue A, Zheng L, Tan G, Wu S, Wu Y, Cheng L, Qu J (2018) Genipin-crosslinked donor sclera for posterior scleral contraction/reinforcement to fight progressive myopia. Invest Ophthalmol Vis Sci 59(8):3564–3573. CrossRefGoogle Scholar
  21. 21.
    Xue A, Bao F, Zheng L, Wang Q, Cheng L, Qu J (2014) Posterior scleral reinforcement on progressive high myopic young patients. Optom Vis Sci 91(4):412–418. CrossRefGoogle Scholar
  22. 22.
    Gupta P, Thakku SG, Saw SM, Tan M, Lim E, Tan M, Cheung CMG, Wong TY, Cheng CY (2017) Characterization of choroidal morphologic and vascular features in young men with high myopia using spectral-domain optical coherence tomography. Am J Ophthalmol 177:27–33. CrossRefGoogle Scholar
  23. 23.
    Gupta P, Cheung CY, Saw SM, Bhargava M, Tan CS, Tan M, Yang A, Tey F, Nah G, Zhao P, Wong TY, Cheng CY (2015) Peripapillary choroidal thickness in young Asians with high myopia. Invest Ophthalmol Vis Sci 56(3):1475–1481. CrossRefGoogle Scholar
  24. 24.
    Garcia-Ben A, Kamal-Salah R, Garcia-Basterra I, Gonzalez Gomez A, Morillo Sanchez MJ, Garcia-Campos JM (2017) Two- and three-dimensional topographic analysis of pathologically myopic eyes with dome-shaped macula and inferior staphyloma by spectral domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 255(5):903–912. CrossRefGoogle Scholar
  25. 25.
    Flores-Moreno I, Lugo F, Duker JS, Ruiz-Moreno JM (2013) The relationship between axial length and choroidal thickness in eyes with high myopia. Am J Ophthalmol 155(2):314–319 e311. CrossRefGoogle Scholar
  26. 26.
    Fledelius HC, Jacobsen N, Li XQ, Goldschmidt E (2018) Choroidal thickness at age 66 years in the Danish high myopia study cohort 1948 compared with follow-up data on visual acuity over 40 years: a clinical update adding spectral domain optical coherence tomography. Acta Ophthalmol 96(1):46–50. CrossRefGoogle Scholar
  27. 27.
    Ikuno Y, Maruko I, Yasuno Y, Miura M, Sekiryu T, Nishida K, Iida T (2011) Reproducibility of retinal and choroidal thickness measurements in enhanced depth imaging and high-penetration optical coherence tomography. Invest Ophthalmol Vis Sci 52(8):5536–5540. CrossRefGoogle Scholar
  28. 28.
    El Matri L, Bouladi M, Chebil A, Kort F, Bouraoui R, Largueche L, Mghaieth F (2012) Choroidal thickness measurement in highly myopic eyes using SD-OCT. Ophthalmic Surg Lasers Imaging 43(6 Suppl):S38–S43. CrossRefGoogle Scholar
  29. 29.
    Nickla DL, Totonelly K (2015) Choroidal thickness predicts ocular growth in normal chicks but not in eyes with experimentally altered growth. Clin Exp Optom 98(6):564–570. CrossRefGoogle Scholar
  30. 30.
    Wildsoet C, Wallman J (1995) Choroidal and scleral mechanisms of compensation for spectacle lenses in chicks. Vis Res 35(9):1175–1194CrossRefGoogle Scholar
  31. 31.
    Wu H, Chen W, Zhao F, Zhou Q, Reinach PS, Deng L, Ma L, Luo S, Srinivasalu N, Pan M, Hu Y, Pei X, Sun J, Ren R, Xiong Y, Zhou Z, Zhang S, Tian G, Fang J, Zhang L, Lang J, Wu D, Zeng C, Qu J, Zhou X (2018) Scleral hypoxia is a target for myopia control. Proc Natl Acad Sci U S A 115(30):E7091–E7100. CrossRefGoogle Scholar
  32. 32.
    Harper AR, Summers JA (2015) The dynamic sclera: extracellular matrix remodeling in normal ocular growth and myopia development. Exp Eye Res 133:100–111. CrossRefGoogle Scholar
  33. 33.
    McBrien NA, Cornell LM, Gentle A (2001) Structural and ultrastructural changes to the sclera in a mammalian model of high myopia. Invest Ophthalmol Vis Sci 42(10):2179–2187Google Scholar
  34. 34.
    Qi Y, Duan AL, You QS, Jonas JB, Wang N (2015) Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia. Retina 35(2):351–357. CrossRefGoogle Scholar
  35. 35.
    Zhu SQ, Pan AP, Zheng LY, Wu Y, Xue AQ (2018) Posterior scleral reinforcement using genipin-cross-linked sclera for macular hole retinal detachment in highly myopic eyes. Br J Ophthalmol.
  36. 36.
    Chan MP, Grossi CM, Khawaja AP, Yip JL, Khaw KT, Patel PJ, Khaw PT, Morgan JE, Vernon SA, Foster PJ, Eye UKB, Vision C (2016) Associations with intraocular pressure in a large cohort: results from the UK Biobank. Ophthalmology 123(4):771–782. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmologythe Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Laboratory of Lens Research of Liaoning ProvinceShenyangChina
  2. 2.Laboratory of Chronic Diseases and Environmental Genomics, School of Public HealthChina Medical UniversityShenyangChina

Personalised recommendations