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Scleral reinforcement surgery
Scleral reinforcement is a surgical procedure used to reduce or stop further macular damage caused by high myopia, which often can be degenerative.
==High myopia==
Myopia is one of the leading causes of blindness in the world.〔Grossniklaus, H.E. and W.R. Green, Pathologic findings in pathologic myopia. Retina, 1992. 12(2): p. 127-33.〕〔Bores, L.D., Scleral Reinforcement, in Refractive Eye Surgery. 2001, Blackwell Science, Inc.: USA. p. 466-491.〕 It is caused by both genetic 〔Curtin, B.J., The nature of pathological myopia, in The Myopias. 1985, Harper & Row: Philadelphia. p. 237-239.〕 and environmental factors,〔Saw, S., et al., Myopia: gene-environment interaction. Annals of the Academy of Medicine, Singapore, 2000. 29(3): p. 290.〕 such as mechanical stretching, excessive eye work and accommodation, as well as an elevated intraocular pressure. 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.
Degenerative myopia, also known as malignant, pathological, or progressive myopia, is characterized by posterior sclera elongation and thinning (at least 25.5 mm to 26.5 mm) and high refractive errors of at least -5 to -7.5 diopters with an increase per year.〔 There may also be changes in the fundus, 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. Staphyloma 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 optic nerve and retinal vessels, but the posterior pole type is the most common.〔Curtin, B.J., The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc, 1977. 75: p. 67-86.〕 As the posterior staphyloma enlarges, choroidal tissue becomes thin and Bruch's membrane begins to break, creating lesions called lacquer cracks. Neovascularization may occur, causing blood vessels to protrude through the cracks and leak in the space underneath the photoreceptor cell layer. This hemorrhaging can lead to scarring and macular degeneration, causing vision to gradually deteriorate.〔 If left untreated, high myopia can cause retinal detachment, glaucoma, and a higher risk of cataracts.
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