充分认识后巩膜加固术的临床价值

在科技高速发展的今天，临床对高度近视眼的屈光矫正虽然有许多较好的解决方法，但矫正后往往仍有屈光进展；对于高度近视眼底病变虽有一些先进的治疗技术在应用，但往往难以逆转和控制已发生的眼底病变，成为患者致盲的主要威胁。而从临床观察角度来看，高度近视的屈光进展及眼底病变的发生和加重与患者的病程进展有关，屈光进展是后巩膜扩张眼轴延长引起的，眼底病变是脉络膜、视网膜对抗后巩膜扩张的表现。后巩膜加固术作为控制后巩膜扩张的方法，其机制的合理性毋容置疑，但既往受科技发展水平的限制，术式和材料难以符合手术机制的要求，不能发挥其真正的作用，故未能得到临床的广泛认同。近年来随着术式和材料的改进，后巩膜加固术稳定眼轴和治疗黄斑劈裂、裂孔、脱离等方面的疗效，在进一步地得到证实和肯定。临床应重视对高度近视病程进展进行控制，充分认识后巩膜加固术的临床价值，把控制和治疗高度近视眼底病变作为手术适应证选择的要旨在临床稳步开展。随着术式和材料的逐步改进和规范，后巩膜加固术的临床疗效将不断提高，有望成为高度近视盲防控的一项关键技术。

Understanding the clinical value of posterior scleral reinforcement

With the rapid development of modem medicine,there are several approaches for correcting refractive errors in high myopia.However,refractive progression after correction still continues.On the other hand,the management of fundus pathology in high myopia often fails to reverse or control the progression of the disease.Despite application of some advanced treatments,fundus pathology has become the main cause of blindness in these patients.Refractive progression is the result of scleral expansion and axial elongation and fundus pathology is a reaction of the choroid and retina to posterior scleral expansion.Therefore,intervention should be aimed at scleral expansion.There is no doubt about the rationality of controlling scleral expansion with posterior scleral reinforcement (PSR).However,this approach was restricted by the status of medicine and technology in the past because surgical techniques and materials could not meet the essential requirements for the surgery to have a real effect.As a result,PSR failed to gain wide clinical recognition.In recent years,as surgical techniques and materials have improved,the efficacy of PSR to stabilize axial length progression and treat macular retinoschisis,macular hole and macular detachment were further confirmed.Full attention should be paid to controll the progression of high myopia and fully understand the clinical value of PSR.The clinical indications of PSR should be to control and treat fundus pathology in high myopia.With gradual improvement and standardization of the surgical procedures and materials,the clinical results of PSR will continue to improve,and PSR is expected to become a key option for preventing blindness in high myopia.