An analysis of the late results of scleroplasty in progressive myopia

Analysis of remote (to 9 years) results after 256 sclera-enhancing operations in patients with progressive myopia, aged from 7 to 48 years, revealed stabilization of the process in 72% of patients, the dependence of the effect on the form of myopia and the patient's age. As to prognosis, early acquired myopia and the children age are less favourable. The number of surgical failures increases in remote terms; in some patients the effect can be transitory. Therefore, surgical results should be judged about minimum 3 years after operation. Comparative examination of the state of a complex "graft-sclera" by means of computer tomography in satisfactory and unsatisfactory surgical results has shown that myopia continues to progress, as a rule, in case of reduced scleral density and the absence of roentgenologic signs of the graft. The action of scleroplasty on the appearance and course of central chorioretinal dystrophies has been studied.     

Scleroplasty as a prophylaxis against blindness and asthenopia in children with progressive myopia

Remote results from 1.5 to 5 years, after sclera-enhancing operations on occasion of myopia in 51 children, of them 17 with congenital, 13--early acquired and 21--school myopia, have shown stabilization of school myopia in 88.9%, congenital--in 87% and early acquired--in 75% of cases; a rise of visual acuity in school and early acquired myopia is observed in a greater number of cases, than in congenital myopia. Scleroplasty is one of main methods to prevent blindness and poor vision in children with myopia.     

Choice of a scleroplasty method in progressive myopia in children]

Dynamic analysis of the results of sclera-fortifying interventions (scleroplasty and sclera-fortifying injection) in children aged 8 to 12 has demonstrated that in many cases myopia stabilized but temporarily after sclera fortification in children with progressive myopia. Repeated sclera-fortifying interventions reduced the rate of postoperative myopia progress approximately twofold, the myopia stabilization period lasting for 1 to 2 years; in some cases myopia progress ceased after a repeated intervention. In 67% of patients myopia on the second eye did not progress for 6 months after sclera-fortifying injection and for a year after scleroplasty on the first eye. Sclera fortification in the paired eye is advisable within these periods. Analysis of the results from the viewpoint of the general mechanisms of scleroplasty effect has lead the authors to a conclusion that sclera-fortifying therapy of children with high progressive myopia should be carried out in several stages. A system of sclera-fortifying treatment of progressive myopia has been developed, and the continuity of methods used for this purpose validated. Effects of this treatment scheme on refraction and status of the fundus oculi are estimated.     

Laser-assisted subepithelial keratectomy in children

PURPOSE: To evaluate whether laser-assisted subepithelial keratectomy (LASEK) achieves effective targeted myopic correction with less post-treatment corneal haze than observed with photorefractive keratectomy (PRK) in children who fail traditional forms of treatment for myopic anisometropic amblyopia and high myopia. SETTING: Nonhospital surgical facility with follow-up in a hospital clinic setting. METHODS: This prospective study comprised 36 eyes of 25 patients. The mean patient age at treatment was 8.27 years (range 1.0 to 17.4 years). Patients were divided into 3 groups: those with myopic anisometropic amblyopia (13 patients/13 eyes), those with bilateral high myopia (11 patients/22 eyes), and those with high myopia post-penetrating keratoplasty (1 patient/1 eye). All patients were treated with LASEK under general anesthesia using the Visx 20/20 B excimer laser and a multizone, multipass ablation technique. Although the myopia was as high as -22.00 diopters (D) spherical equivalent (SE) in some eyes, no eye was treated for more than -19.00 D SE. RESULTS: At 1 year, the mean SE decreased from -8.03 D to -1.19 D. Forty-four percent of eyes were within +/-1.0 D of the targeted correction; 78% of eyes had clear corneas with no haze. In the entire group, the mean best corrected visual acuity improved from 20/80 to 20/50. A functional-vision survey demonstrated a positive effect on the patients' ability to function in their environments after LASEK. CONCLUSIONS: Laser-assisted subepithelial keratectomy in children represents another method of providing long-term resolution of bilateral high myopia and myopic anisometropic amblyopia with minimal post-laser haze. The reduction in post-laser haze with LASEK compared to that with the standard PRK technique may represent an advantage in treating these complex patients.     

Scleroplasty surgery. I. Results in children]

The authors give an account on the results of scleroplastic operations (according Pivovarov) in 159 children (298 eyes). They describe in detail the surgical procedure, the mechanism of action of the operation, the fate of the implanted material. The most suitable material for scleroplastic operations in children is the irradiated human sclera which caused the minimal incidence of complications. Most frequently eyes with the diagnosis myopia progressiva 57.7% were operated, another large group were eyes with the diagnosis of myopia gravis -35.2%. The mean age at the time of operation was 11.3 +/- 3.3 years. In myopia progressiva the correction was three years after operation the same or lower in 53.3% of the operated patients, the vision was equal or better in 80% of the operated patients. In children with myopia progressiva who were operated at the age of 10-15 years, after three years no difference in vision was recorded as compared with the finding before operation; the correction changed on average only by 0.27 dioptres. This result is very satisfactory, as indication for operation was progression of myopia by at least 1 dioptre per year before operation. In myopia gravis the correction was three years after operation equal or lower in 68.4% of operated eyes, the vision was equal or better in 81.6% of the operated eyes. Reinforcement of the sclera--scleroplasty--is at the moment the only rational therapeutic method of progressing and severe myopia.     

Surgical treatment of congenital myopia in children

Ophthalmological data and results of surgical treatment in 81 children with congenital myopia are analysed. The methods used were simple, accessible for children ophthalmological practice: scleroplasty after Pivovarov-Pristavko (group I), modified chondroplasty (group II), simplified scleroplasty with revascularization of the Tenon's capsule after Beliaev (group III). Analysis of immediate results of operation has shown that any method of scleroplasty leads to increase of visual acuity, reduction of refraction and shortening of the anteroposterior axis of the eye. Signs of tenonitis after operation were recorded in most of the patients from group I, in one third of cases in group III and were absent in group II. The choice of the surgical method should be differential considering ophthalmological data of each patient. In children practice simplified methods of scleroplasty should be used, including chondroplasty, allowing to shorten the time of operation and to prevent operative and postoperative complications.     

学龄儿童近视的预防与控制

近视的低龄化,近视发展的速度加快,这可能预示着罹患高度近视的人数以及高度近视所导致的低视力和失明的人数会增加。由学龄期获得并逐渐加深的近视会造成高度近视的流行,从而影响人们的工作、学习和日常生活。学龄儿童近视不仅仅是一个公共卫生问题,还会加重社会经济负担。我国近视人群比例约占47%,近视已经成为我国的“国病”。我国学龄儿童近视发病率高。学龄儿童近视的危害大。近年来,学龄儿童近视的预防及控制措施成为研究的重点。现就学龄儿童近视的预防与控制措施进行综述,以期为学龄儿童近视的防控提供新的线索。     

Myopia prevalence in Chinese-Canadian children in an optometric practice.

PURPOSE: The high prevalence of myopia in Chinese children living in urban East Asian countries such as Hong Kong, Taiwan, and China has been well documented. However, it is not clear whether the prevalence of myopia would be similarly high for this group of children if they were living in a Western country. This study aims to determine the prevalence and progression of myopia in ethnic Chinese children living in Canada. METHODS: Right eye refraction data of Chinese-Canadian children aged 6 to 12 years were collated from the 2003 clinical records of an optometric practice in Mississauga, Ontario, Canada. Myopia was defined as a spherical equivalent refraction (SER) equal or less than -0.50 D. The prevalence of myopia and refractive error distribution in children of different ages and the magnitude of refractive error shifts over the preceding 8 years were determined. Data were adjusted for potential biases in the clinic sample. A questionnaire was administered to 300 Chinese and 300 Caucasian children randomly selected from the clinic records to study lifestyle issues that may impact on myopia development. RESULTS: Optometric records of 1468 children were analyzed (729 boys and 739 girls). The clinic bias adjusted prevalence of myopia increased from 22.4% at age 6 to 64.1% at age 12 and concurrently the portion of the children that were emmetropic (refraction between -0.25 and +0.75 D) decreased (68.6% at 6 years to 27.2% at 12 years). The highest incidence of myopia for both girls ( approximately 35%) and boys ( approximately 25%) occurred at 9 and 10 years of age. The average annual refractive shift for all children was -0.52+/-0.42 D and -0.90+/-0.40 D for just myopic children. The questionnaire revealed that these Chinese-Canadian children spent a greater amount of time performing near work and less time outdoors than did Caucasian-Canadian children. CONCLUSIONS: Ethnic Chinese children living in Canada develop myopia comparable in prevalence and magnitude to those living in urban East Asian countries. Recent migration of the children and their families to Canada does not appear to lower their myopia risk.     

Myopia and orthokeratology for myopia control

The prevalence of myopia in children is increasing worldwide and is viewed as a major public health concern. This increase has driven interest in research into myopia prevention and control in children. Although there is still uncertainty in the risk factors underlying differences in myopia prevalence between ethnic groups, rates in children of East Asian descent are typically higher regardless of where they live. Mounting evidence also suggests that myopia prevalence in children increases with age. Earlier commencement and more rigorous education systems in these countries, resulting in more time spent on near‐work activities and less time on outdoor activities, may be responsible for the earlier age of myopia onset. However, to date, the mechanisms regulating myopia onset and progression are still poorly understood. Findings from several studies have shown orthokeratology to be effective in slowing axial elongation and it is a well‐accepted treatment, particularly in East Asian regions. While our understanding of this treatment has increased in the last decade, more work is required to answer questions, including: How long should the treatment be continued? Is there a rebound effect? Should the amount of myopia control be increased? To whom and when should the treatment be offered? Practitioners are now faced with the need to carefully guide and advise parents on whether and when to undertake a long somewhat complex intervention, which is costly, both in time and money. In the near future, a greater demand for effective prophylaxis against childhood myopia is envisaged. Other than orthokeratology, atropine therapy has been shown to be effective in slowing myopia progression. While its mechanism of control is also not fully understood, it is likely that it acts via a different mechanism from orthokeratology. Thus, a combined treatment of orthokeratology and atropine may have great potential to maximise the effectiveness of myopia control interventions.     

Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children

PURPOSE: To examine baseline measurements of accommodative lag, phoria, reading distance, amount of near work, and level of myopia as risk factors for progression of myopia and their interaction with treatment over 3 years, in children enrolled in the Correction of Myopia Evaluation Trial (COMET). METHODS: COMET enrolled 469 ethnically diverse children (ages, 6-11 years) with myopia between -1.25 and -4.50 D. They were randomly assigned to either progressive addition lenses (PALs) with a +2.00 addition (n = 235) or single vision lenses (SVLs; n = 234), the conventional spectacle treatment, and were observed for 3 years. The primary outcome measure was progression of myopia by autorefraction after cycloplegia with 2 drops of 1% tropicamide. Other measurements included accommodative response (by an open field of view autorefractor), phoria (by cover test), reading distance, and hours of near work. Independent and interaction analyses were based on the mean of the two eyes. Results were adjusted for important covariates with multiple linear regression. RESULTS: Children with larger accommodative lags (>0.43 D for a 33 cm target) wearing SVLs had the most progression at 3 years. PALs were effective in slowing progression in these children, with statistically significant 3-year treatment effects (mean +/- SE) for those with larger lags in combination with near esophoria (PAL - SVL progression = -1.08 D - [-1.72 D] = 0.64 +/- 0.21 D), shorter reading distances (0.44 +/- 0.20 D), or lower baseline myopia (0.48 +/- 0.15 D). The 3-year treatment effect for larger lags in combination with more hours of near work was 0.42 +/- 0.26 D, which did not reach statistical significance. Statistically significant treatment effects were observed in these four groups at 1 year and became larger from 1 to 3 years. CONCLUSIONS: The results support the COMET rationale (i.e., a role for retinal defocus in myopia progression). In clinical practice in the United States children with large lags of accommodation and near esophoria often are prescribed PALs or bifocals to improve visual performance. Results of this study suggest that such children, if myopic, may have an additional benefit of slowed progression of myopia.     

Multifocal electroretinogram in children on atropine treatment for myopia

AIM: To assess retinal function by multifocal electroretinogram (mfERG) in children on atropine eye drops for the treatment of myopia. METHODS: mfERGs were recorded in children receiving atropine eye drops (n = 48) once daily for 2 years and in those receiving placebo eye drops (n = 57) for a similar time. All recordings were performed between the second and third month of cessation of atropine/placebo treatment by a masked investigator. The amplitude and implicit time of the first order kernel (k1) and first slice of the second order kernel (k21) of mfERG responses were used to study the outer and inner retinal function, respectively. RESULTS: There was no significant reduction in k1 response amplitudes of the atropine group compared to that of the placebo group (N1, p = 0.181; P1, p = 0.150). No significant difference in the k1 response implicit times between the groups was found (N1, p = 0.767; P1, p = 0.849). The differences in the k21 amplitudes and implicit times between the groups were not statistically significant (k21 amplitude, p = 0.058; k21 implicit time, p = 0.156). CONCLUSIONS: Daily atropine usage over 2 years for the treatment of myopia has no significant effect on retinal function as demonstrated by recordings of mfERG.     

Factors associated with high myopia after 7 years of follow-up in the Correction of Myopia Evaluation Trial (COMET) Cohort

PURPOSE: To evaluate factors associated with the development of high myopia (worse than -6.00 D) over 7 years of follow-up in the COMET cohort. METHODS: COMET enrolled 469 ethnically diverse children (6-11 years) with myopia between -1.25 and -4.50 D. They were randomized to either progressive addition lenses (PALs) or single vision lenses (SVLs), and followed for 5 years in their original lens assignment and 2 additional years wearing either spectacles (PALs or SVLs) or contact lenses. Refractive error was measured annually by cycloplegic autorefraction and axial length by A-Scan ultrasonography. Myopia for each child was defined as the mean spherical equivalent refractive error (SER) of the 2 eyes. Analyses were based on 7 years of follow-up. Time to high myopia was analyzed by Cox proportional hazard models and linear regression. Parental refraction data were available from 240 COMET subjects. RESULTS: Younger (6-7 years) versus older (11 years) age at baseline was a significant risk factor (adjusted hazard ratio (HR) = 6.6, 95% CI = 3.4, 12.7) for having high myopia within 7 years. More (SER from -2.26 to -4.50 D) vs. less (SER from -1.25 to -2.25 D) baseline myopia was also a significant risk factor for high myopia at 7 years (adjusted HR = 7.4, 95% CI = 4.4, 12.4). Gender, ethnicity, and treatment assignment were not associated with the risk of high myopia within 7 years. Increased number of myopic parents was associated with a significant risk of high myopia in the children (p = 0.008). CONCLUSIONS: Children who developed high myopia during 7 years of follow-up were younger and had more myopia at baseline. They also were more likely to have two myopic parents. These children may be at greater risk for sight-threatening conditions later in life.     

儿童青少年屈光不正十年变化的探讨

目的:通过比较研究十年前后(1998/2000年和2008/2010年)的验光资料,分析儿童青少年近视眼发生发展情况,为深入研究近视眼的发生、发展规律和防治提供依据。方法:将1998/2000年(十年前组)与2008/2010年(十年后组)来我院就诊的门诊病例随机抽样,按年龄分为3组,≤6岁为儿童组,7～12岁为小学组,13～18岁为中学组。将其验光结果进行统计分析。结果:十年前后两组的平均屈光度进行统计学分析比较有显著差异,并显示近视眼发生发展年龄呈前移趋势(P<0.01)。按年龄分组对十年前后两组的屈光度分别进行统计学分析,小学组和中学组的屈光度明显增加,有显著差异(均P<0.01)。通过对十年前后组屈光度与年龄的关系的统计分析,近视小学组患病眼数明显增加,从35.2%增到50.0%。中学组十年后组患眼比例有所减少,儿童组变化不明显。将屈光度分为低度、中度、高度三组进行比较,近视中学组变化最大,中度近视眼数较十年前组增加了11.4%,高度近视眼数增加了7.9%。结论:通过我们的研究表明近视眼发生的年龄提前,屈光度增加近1.00D,可能是现代生活方式以及生活环境的改变,近视眼的发病率日渐增加,儿童青少年近视眼的发生年龄日渐提前,因此预防近视的工作要从小做起,预防的重点要放在幼儿园和小学阶段。     

The development of myopia in Hong Kong children between the ages of 7 and 12 years: a five-year longitudinal study

The purpose of this work was to characterize the development of refractive error in Hong Kong children between the ages of 7 and 12 years. A non self-selected sample of 7-year old children was recruited and followed for 5 years, non-cycloplegic refractions being carried out annually. A life-table was used to determine myopia incidence and prevalence. The mean annual change in the spherical equivalent refraction (SER) was -0.32 D; 75 out of 83 subjects followed for 5 years became less hyperopic or more myopic, the maximum progression occurring between 9 and 11 years of age. The mean change in SER over the 5 years in children who were myopic at age 12 years was significantly greater than that in children who remained non-myopic. The incidence of myopia at age 7-8 years was 9% and at age 11-12 years was 18-20%. At age 7 years the prevalence of progressive myopia was 1.6% and 2.5% of subjects had anisometropia. Any treatment to prevent myopia should start by the age of 6 years and treatment to retard development should commence before age 9 years.     

An epidemiological study of the ocular and visual profiles of Oklahoma Cherokees and Minnesota Chippewas

Over the last three decades some American Indian tribes in North America have received attention in the literature as a minority group with unique visual characteristics. Studies on the refractive status of Indians have shown an increase of refractive errors and particularly an abnormally high prevalence, and amount of, with-the-rule astigmatism. These changes appear to have taken place over the last 40 years. Eskimos, on the other hand, have recently showed an astoundingly high incidence of myopia. Other Native American tribes do not show dramatic changes in myopia or astigmatism. The Public Health Service-Indian Health Service, as an ongoing aspect of their responsibilities to Native Americans, perform screenings on children. This study reports the results of visual screenings primarily of Oklahoma Cherokee and Minnesota Chippewa children.     

病理性近视黄斑病变的研究进展

病理性近视眼轴过度伸长所引起的一系列眼底改变,尤其是黄斑病变,是造成视力下降或致盲的主要因素。近年来,随着高度近视和病理性近视患病率的增高,人们对病理性近视的眼底并发症也越来越重视。防治病理性近视导致的视力不可逆损害成为了一大难题。基于最新的近视性黄斑病变的分类即ATN分类系统,本文将从萎缩(A)、牵拉(T)和新生血管(N)三方面讨论各类病理性近视黄斑病变的眼底特征、诊断和治疗方法的最新进展。     

学龄前早产儿近视的屈光参数研究

目的:研究1~6岁早产儿近视患者屈光参数的变化,探讨早产儿近视发生发展与屈光参数的关系。方法:收集2016-01/2018-12在湖南省儿童医院眼科门诊随诊的1~6岁早产儿近视者158例316眼作为早产儿近视组,选取同期随诊的早产儿非近视者164例328眼作为早产儿非近视组。检测并分析两组受检者角膜曲率(CR)、前房深度(ACD)、玻璃体腔深度(VITR)、眼轴长度(AL)、晶状体厚度(LT)等屈光参数。结果:1~3岁受检者中,早产儿近视组较早产儿非近视组CR陡(44.47±1.14D vs 43.38±1.22D),AL延长(21.89±0.71mm vs 21.24±0.56mm)(均P<0.05),而ACD、VITR及LT值无明显差异(均P>0.05);4~6岁受检者中,早产儿近视组较早产儿非近视组AL延长(22.49±1.32mm vs21.43±0.72mm,P<0.05),而CR、ACD、VITR及AT值无明显差异(均P>0.05)。1~3岁早产儿高度近视患者较低、中度近视患者CR陡、AL长,4~6岁早产儿高度近视患者较低、中度近视患者VITR深、AL长。结论:屈光参数发育不匹配可能是早产儿近视发生的原因之一,其中眼轴长度变化起主要作用,而角膜曲率陡是低龄(≤3岁)早产儿近视发展的重要因素之一。     

Myopia in Singapore kindergarten children.

PURPOSE: The purpose of this study was to examine whether close-up work was related to myopia in Singapore kindergarten children. METHODS: One hundred twenty-eight children, ages 3 to 7 years, from a kindergarten in Singapore were examined by cycloplegic autorefraction. The parents also completed a questionnaire on the different types of close-up work activities each child was engaged in, socioeconomic status, and parental history of myopia. RESULTS: Myopic children spent 3.0 hours per day (median) on close-up work activity, while nonmyopic children spent 2.0 hours per day (median) on close-up work activity. The prevalence of myopia in the sample was 8.6%. CONCLUSION: Close-up work activity was not related to myopia in pre-school children.     

近视性巩膜重塑相关因子研究进展

近视患病率近年来逐年上升，已成为影响青少年视力健康的主要问题。研究表明，眼球后极部巩膜重塑是近视发展和眼轴进行性延长过程的关键事件。其中，基质金属蛋白酶、生长因子、视黄酸等相关因子在近视性巩膜重塑过程中发挥了重要作用。本文就影响近视巩膜基质重塑的相关因子及其在近视发展过程中的作用进行综述，为近视防控与治疗提供新的思路。     

Role of Cycloplegics in Progressive Myopia

Atropine sulfate 1% was instilled in both eyes of 86 children (172 eyes) on a daily basis for a period of two to eight years. No untoward changes in intraocular pressure, pupillary response, accommodation, or appearance of the ocular fundi were noted. A comparison with a similar group of children having only glasses prescribed during a similar time span revealed that atropine is effective in reducing the progression of myopia in children; a permanent reduction in the degree of myopia may be achieved. Relaxation of accommodation by means of cycloplegic drugs may be a safe and effective treatment of myopia.