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

AIM： To investigate the effect of posterior scleral reinforcement （PSR） on circulation of pathologic myopia eyes with posterior staphyloma by optical coherence tomography angiography （OCTA）.METHODS： 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. RESULTS： 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.CONCLUSION： 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.

Posterior scleral reinforcement for the treatment of pathological myopia

AIM： To investigate the effects of posterior scleral reinforcement（PSR） in the treatment of pathological myopia.·METHODS： 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, 3and 5y after the surgery, and the complications were noted.·RESULTS： 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 log MAR） and the control group（0.62±0.26 log MAR） at the postoperative 5-year follow-up（P 〈0.01）. There were no serious complications during the 5-year follow-up period.·CONCLUSION： PSR can prevent axial elongation and myopia progression in eyes with pathological myopia.

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy

AIM: To report the long-term outcome of posterior scleral reinforcement(PSR) followed by vitrectomy for pathologic myopic foveoschisis(MF).METHODS: The records of 27 patients(44 eyes) treated with posterior scleral reinforcement(PSR) followed by vitrectomy for pathologic MF were retrospectively reviewed.The best-corrected visual acuity(BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings and complications were analyzed.RESULTS: Forty-four eyes of 27 patients were included in this study. The follow-up period was 47.98±18.23mo(24-83mo). The mean preoperative BCVA(logMAR) was 1.13±0.63, and the mean postoperative BCVA was 0.30±0.33at the last visit. There showed a significant improvement in BCVA postoperatively(P<0.001). Postoperative BCVA in 41eyes(93%) was improved compared with the preoperative one. Forty-two eyes(95.45%) got total resolution of the MF after surgery. The remaining two eyes(4.55%) got partial resolution of foveoschisis. The preoperative foveal thickness was 610.45±217.11 μm and the postoperative foveal thickness at the last visit was significantly reduced to 177.64±55.40 μm(P<0.001). The preoperative axial length was 29.60±1.71 mm, and the postoperative axial length was 29.74±1.81 mm at the last visit. There was no significant increase in axial length within 47.98±18.23mo of follow-up(P=0.562). There was no recurrence of foveoschisis or occurrence of full-thickness macular hole during the whole follow-up period.CONCLUSION: For pathologic MF, PSR followed by vitrectomy is an effective procedure to improve the visual acuity and the anatomical structure of macula. It can also stabilize the axial length for a long time.