Clinical Analysis Of Posterior Scleral Reinforcement In The Treatment Of Pathological Myopia

Background:The incidence of myopia is increasing year by year,and the incidence of pathological myopia is also rising year by year.The treatment of pathological myopia fundus lesions include vitreoretinal surgery,retinal laser surgery,intraocular gas injection,etc.,but fundus lesions often continue to develop.Can not be reversed and controlled,becoming a major threat to blindness.This study explored the clinical efficacy of scleral reinforcement for the treatment of pathological myopia.The research content is divided into two parts.The first part Objective: To evaluate the clinical efficacy of posterior scleral reinforcement for pathological myopia,and provide a basis for the control and treatment of pathological myopia.Methods: From January 2012 to August 2013,a retrospective analysis of pathological myopia in the Second affiliated Hospital of Anhui Medical University(no macular hole,macular retinal detachment,etc.): 26 patients(46 eyes)Macular lesions,including17 males,30 eyes,9 females,16 eyes,aged 8 to 49 years,mean(33.9 ± 9.0)years old.All patients were followed for more than 1 year.All operations were performed by experienced doctors in our hospital.All patients signed the informed consent form for surgery before surgery and were approved by the Ethics Committee of the SecondAffiliated Hospital of Anji Medical College.The primary outcome measure was best corrected visual acuity,axial length,diopter and complications.All patients underwent a comprehensive eye exam before surgery and at 1,3,and 12 months after surgery.Result:1.Vision: There was no significant difference in visual acuity between 3 months and 1year after operation,and the difference was not statistically significant(P > 0.05).2.Axial axis: The length of the axial length was shortened at 1 month and 3 months after operation,and the difference was statistically significant(P <0.05).Compared with the preoperative eye axis,there was no significant change at 1 year after operation,and the difference was not statistically significant(P > 0.05).3.Diopter: The diopter at 1 month and 3 months after operation was lower than the preoperative diopter,and the difference was statistically significant(P <0.05).There was no significant change in preoperative 1 year and preoperative diopter(P > 0.05).In conclusion:1.Posterior scleral reinforcement for the treatment of pathological myopia is safe and effective to delay axial growth2.Postoperative axial position and diopter gradually increased,although 1 year after surgery was still lower than preoperative,but the difference was not statistically significant compared with preoperative;3.The posterior scleral reinforcement material should be placed in the posterior or posterior scleral staphyloma,and the eye shaft should be shortened by appropriate pressure.The second part Objective: To evaluate the clinical efficacy of posterior scleral reinforcement for the treatment of high myopia and macular splitting,and to provide evidence for the control and treatment of high myopia fundus lesions.Methods: A retrospective analysis of 21 patients(26 eyes)who underwent posterior scleral reinforcement in the Department of Ophthalmology of Second affiliated Hospital of Anhui Medical University from March 2014 to January 2016,including 8 males and11 patients Eyes,13 eyes of 15 women,aged 30 to 61 years,mean(46.1 ± 9.3)years old.All operations were performed by an experienced doctor in our hospital.All patients had signed informed consent for surgery before surgery,and were approved by the Ethics Committee of the Second Affiliated Hospital of Anji Medical College.The primary outcome measures were best corrected visual acuity,axial length,diopter,central macular thickness,and complications.All patients underwent a comprehensive eye exam before surgery and at 3,6,12,18,and 24 months after surgery.Including the best corrected visual acuity(log MAR),diopter,OCT(Heidelberg,Germany)to measure the thickness of the central region of the macula,IOLMaster inspection.The method of homologous comparison after OCT and preoperative use.Postoperative visual acuity changes were defined as changes ≥ 0.2(log MAR).Result:1.Vision: The BCVA(Log MAR)was 0.82±0.10 at the last follow-up,which was significantly higher than the preoperative 1.26±0.16(Z=-3.784,P=0.000).2.Axial axis: The axial length of the eyes was shortened from 3 months to 18 months after operation,and the difference was statistically significant(P<0.05).The postoperative 24 months was not obvious compared with the preoperative shortening.No statistical significance(P>0.05).3.Diopter: The diopter decreased 3 months after operation,6 months after operation and 12 months after operation,the difference was statistically significant(P<0.05),18 months after operation and 24 after operation.The monthly diopter mean was greater than the preoperative mean,and the difference was not statistically significant(P >0.05).4.The thickness of the foveal fovea was significantly lower than that before surgery,and the difference was statistically significant(P=0.000).In conclusion:1.Posterior scleral reinforcement for the treatment of high myopia macular fissure is safe and effective during the 2-year follow-up period;2.The postoperative axial and diopter progressive growth,resulting in less than 1.5months to 2 years after surgery,but compared with preoperative,the difference was not statistically significant;3.The posterior scleral reinforcement material should be placed in the posterior scleral staphyloma,and the eye axis should be shortened by appropriate pressure.