26:
272:
countries, such as the former Soviet Union and Japan. There is also controversy regarding in what developmental stage this procedure should be performed. Some feel efforts should be made as soon as possible to arrest progression in children. Others feel that the procedure should only be done in cases where high myopia is indicated with macular changes. Furthermore, different surgeons have particular criteria that must be met by patients in order to receive surgery.
243:. The connecting tissue is then separated from the posterior pole, as well as the inferior oblique muscle. The strip of material is passed under the separated muscles, and pushed down deeply towards the posterior pole. Both ends of the material strip are crossed over the medial rectus muscle and sutured to the sclera on the medial side of the superior and inferior recti muscles. The conjunctiva and Tenon's capsule are then closed together.
153:
cause, rather than an effect”. Procedures in early literature aimed at shortening the length of the eyeball by resecting a ring of sclera from the equator of the eye. Later procedures focused on modifying the axial length of the eye, by preventing elongation and staphyloma progression by placing grafts over the posterior part of the eye. In 1930, Shevelev proposed the idea of transplantation of
207:, Zenoderm (porcine skin dermis), animal tendons, and donor's or cadaver’s sclera. Human sclera is thought to offer the best support, as well as Lyodura, which is biologically compatible with the eyeball and has sufficient tensile strength. Artificial materials, such as nylon or silicone, are not suggested. Sclera from cadaver’s or animal tendons run the risk of being rejected.
161:, a material derived from processed cadaver dura mater. At this point, many different surgeons made alterations to existing techniques. Snyder and Thompson modified reinforcement techniques and had positive outcomes, while others, like Curtin and Whitmore, expressed dissatisfaction with their negative conclusions.
271:
Scleral reinforcement surgery is not presently popular in the United States, and there has been a scarcity of published clinical studies. Donor sclera material is also difficult to acquire and store, and artificial materials are still being tested. This procedure is much more popular in other
152:
The condition of posterior staphyloma in high myopia was first described by Scarpa in the 1800s. Speculation about reinforcement of the eye began in the 19th century, when Rubin noted that sclera reinforcement “is probably the only one of all the surgical techniques which attempts to correct a
186:
and could result in optic nerve atrophy. In single strip support, the material covers the posterior pole vertically between the optic nerve and insertion of the inferior oblique muscle. Often, this method is preferred, since it is the easiest method for placement, provides the widest area of
481:
107:, including posterior staphyloma, caused by the eye growing posteriorly and losing its spherical shape. Since enlargement of the eye does not progress at a uniform rate, abnormal protrusions of uveal tissue may occur through weak points in the eye.
111:
is marked by a thinning of sclera collagen bundles and decreased number of collagen striations. It correlates with a large posterior temporal bulge. Curtin described five varieties, based on size, shape, and change in appearance of the
173:
and prevent further progression of the posterior staphyloma. The strain is reduced, although damage from the pathological process cannot be reversed. By stopping the progression of the disease, vision may be maintained or improved.
182:
There are three basic techniques, referred to as X-shaped, Y-shaped, and single strip support. In X-shaped and Y-shaped, the arms run the risk of the being pulled medially, which would press on the
92:. It affects both children and adults. In many cases, myopia will stabilize once the growth process has been completed, but in more severe chronic cases, loss of vision can occur.
371:
Shevelev, M.M., Operation against high myopia and scleralectasia with aid of the transplantation of fascia lata on thinned sclera. Russian
Oftalmol J, 1930. 11(1): p. 107-110.
84:
is one of the leading causes of blindness in the world. It is caused by both genetic and environmental factors, such as mechanical stretching, excessive eye work and
444:
Ward, B., Tarutta, E., & Mayer, M. (2009). The efficacy and safety of posterior pole buckles in the control of progressive high myopia. Eye, 23(12), 2169-2174.
359:
Rubin, M.L., Surgical procedures available for influencing refractive error., in
Refractive Anomalies of the Eye. 1966, US Government Printing Office: Washington.
399:
Momose, A., Surgical treatment of myopia.... with special references to posterior scleral support operation and radial keratotomy. Vol. 31. 1983. 759-767.
471:
408:
Snyder, A. and F. Thompson, A simplified technique for surgical treatment of degenerative myopia. American
Journal of Ophthalmology, 1972. 74(2): p. 273.
476:
116:
and retinal vessels, but the posterior pole type is the most common. As the posterior staphyloma enlarges, choroidal tissue becomes thin and
417:
Curtin, B. and W. Whitmore, Long-term results of scleral reinforcement surgery. American
Journal of Ophthalmology, 1987. 103(4): p. 544.
25:
426:
Gerinec, A., & Slezakova, G. (2001). Posterior scleroplasty in children with severe myopia. Bratisl Lek Listy, 102(2), 73-78.
157:
for sclera reinforcement. Curtin promoted the use of donor-sclera grafting for reinforcement. In 1976, Momose first introduced
332:
Saw, S., et al., Myopia: gene-environment interaction. Annals of the
Academy of Medicine, Singapore, 2000. 29(3): p. 290.
383:
Curtin, B.J., Surgical support of the posterior sclera: Part II. Clinical results. Am J Ophthalmol, 1961. 52: p. 253.
323:
Curtin, B.J., The nature of pathological myopia, in The
Myopias. 1985, Harper & Row: Philadelphia. p. 237-239.
95:
Degenerative myopia, also known as malignant, pathological, or progressive myopia, is characterized by posterior
314:
Bores, L.D., Scleral
Reinforcement, in Refractive Eye Surgery. 2001, Blackwell Science, Inc.: USA. p. 466-491.
290:
Grossniklaus, H.E. and W.R. Green, Pathologic findings in pathologic myopia. Retina, 1992. 12(2): p. 127-33.
456:
Thompson, F., Scleral
Reinforcement. Chapter 10., in Myopia Surgery. 1990, Macmillan: New York. p. 267-297.
215:
While there have been many modifications, Thompson’s procedure has often been used as a basis. First, the
236:
232:
341:
Curtin, B.J., The posterior staphyloma of pathologic myopia. Trans Am
Ophthalmol Soc, 1977. 75: p. 67-86.
228:
435:
Balashova, N., Ghaffariyeh, A., & Honarpisheh, N. (2010). Scleroplasty in progressive myopia. Eye.
170:
129:
124:
may occur, causing blood vessels to protrude through the cracks and leak in the space underneath the
89:
117:
85:
133:
125:
121:
220:
169:
The surgery aims to cover the thinning posterior pole with a supportive material to withstand
100:
40:
103:
of at least -5 to -7.5 diopters with an increase per year. There may also be changes in the
240:
251:
Long-term complication rates are usually low, but short-term complications may include
224:
465:
132:, causing vision to gradually deteriorate. If left untreated, high myopia can cause
104:
216:
196:
183:
154:
113:
350:
Scarpa, A. A. (1818). A Treatise on the
Principal Diseases of the Eye. London.
260:
108:
482:
Disorders of ocular muscles, binocular movement, accommodation and refraction
141:
252:
204:
137:
99:
elongation and thinning (at least 25.5 mm to 26.5 mm) and high
52:
200:
158:
66:
96:
81:
70:
31:
256:
195:
Many different materials have been used in the past, including
263:, damage to the vortex vein, and transient motility problems.
187:
support, and reduces the risk of optic nerve interference.
120:
begins to break, creating lesions called lacquer cracks.
65:
is a surgical procedure used to reduce or stop further
128:layer. This hemorrhaging can lead to scarring and
39:
18:
8:
452:
450:
24:
379:
377:
395:
393:
391:
389:
310:
308:
306:
304:
302:
300:
298:
296:
286:
284:
280:
367:
365:
15:
223:are incised about 6 mm from the
30:Schematic diagram of the human eye. (
7:
239:recti muscles are separated using a
48:
14:
472:Visual disturbances and blindness
477:Disorders of choroid and retina
1:
73:, which can be degenerative.
19:Scleral reinforcement surgery
498:
203:(lyophilized human dura),
88:, as well as an elevated
49:
23:
140:, and a higher risk of
69:damage caused by high
63:Scleral reinforcement
171:intraocular pressure
130:macular degeneration
90:intraocular pressure
178:Methods of surgery
134:retinal detachment
126:photoreceptor cell
122:Neovascularization
101:refractive errors
60:
59:
34:labeled on left.)
489:
457:
454:
445:
442:
436:
433:
427:
424:
418:
415:
409:
406:
400:
397:
384:
381:
372:
369:
360:
357:
351:
348:
342:
339:
333:
330:
324:
321:
315:
312:
291:
288:
118:Bruch's membrane
53:edit on Wikidata
28:
16:
497:
496:
492:
491:
490:
488:
487:
486:
462:
461:
460:
455:
448:
443:
439:
434:
430:
425:
421:
416:
412:
407:
403:
398:
387:
382:
375:
370:
363:
358:
354:
349:
345:
340:
336:
331:
327:
322:
318:
313:
294:
289:
282:
278:
269:
249:
241:strabismus hook
221:Tenon's capsule
213:
193:
180:
167:
150:
79:
56:
35:
12:
11:
5:
495:
493:
485:
484:
479:
474:
464:
463:
459:
458:
446:
437:
428:
419:
410:
401:
385:
373:
361:
352:
343:
334:
325:
316:
292:
279:
277:
274:
268:
265:
248:
245:
225:corneal limbus
212:
209:
192:
189:
179:
176:
166:
163:
149:
146:
78:
75:
58:
57:
50:
47:
46:
43:
37:
36:
29:
21:
20:
13:
10:
9:
6:
4:
3:
2:
494:
483:
480:
478:
475:
473:
470:
469:
467:
453:
451:
447:
441:
438:
432:
429:
423:
420:
414:
411:
405:
402:
396:
394:
392:
390:
386:
380:
378:
374:
368:
366:
362:
356:
353:
347:
344:
338:
335:
329:
326:
320:
317:
311:
309:
307:
305:
303:
301:
299:
297:
293:
287:
285:
281:
275:
273:
266:
264:
262:
258:
254:
247:Complications
246:
244:
242:
238:
234:
230:
226:
222:
218:
210:
208:
206:
202:
198:
190:
188:
185:
177:
175:
172:
164:
162:
160:
156:
147:
145:
143:
139:
135:
131:
127:
123:
119:
115:
110:
106:
102:
98:
93:
91:
87:
86:accommodation
83:
76:
74:
72:
68:
64:
54:
45:ophthalmology
44:
42:
38:
33:
27:
22:
17:
440:
431:
422:
413:
404:
355:
346:
337:
328:
319:
270:
255:, choroidal
250:
214:
194:
181:
168:
151:
94:
80:
62:
61:
267:Controversy
217:conjunctiva
197:fascia lata
184:optic nerve
155:fascia lata
114:optic nerve
77:High myopia
466:Categories
276:References
261:hemorrhage
109:Staphyloma
211:Procedure
191:Materials
142:cataracts
41:Specialty
253:chemosis
237:inferior
233:superior
205:Gore-Tex
138:glaucoma
229:lateral
227:. The
201:Lyodura
165:Purpose
159:Lyodura
148:History
67:macular
235:, and
105:fundus
97:sclera
82:Myopia
71:myopia
32:Sclera
257:edema
51:[
219:and
259:or
468::
449:^
388:^
376:^
364:^
295:^
283:^
231:,
199:,
144:.
136:,
55:]
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
