Due to the high incidence and the earlier onset age, high myopia has become an important public health problem in China. Posterior scleral reinforcement surgery has been developed for over 60 years in order to control the rapid progression and complications of high myopia. By suturing a certain size of material on the surface of the posterior eyeball, thickness and elasticity modulus of the local sclera significantly increase. As the result, the rapid growth of the axial length and the chorioretinopathy could be alleviated. At present, controversies about its clinical efficacy and safety still exist, so posterior scleral reinforcement surgery has not been widely carried out all over the world. An in-depth analysis of the mechanism, surgical manipulations and materials, the clinical application status of posterior scleral reinforcement surgery on control of high myopia can provide a basis for further standardized application of this surgery
Pathological myopia, characterized by progressive elongation of the axial length and formation of posterior staphyloma, is accompanied by chorioretinal irreversible degeneration. It is also the focus and biggest challenge of myopia control and blindness prevention. For managing progressive early-onset pathologic myopia and myopic traction maculopathy, episcleral pressurization of macula is a practical option. It can be divided into posterior scleral reinforcement surgery and macular buckling surgery according to the presence or absence of operative top pressure ridge after surgery, both of which are different in terms of implanted materials, procedures and indications. The implanted materials, procedures and indications are different between the two. Under the background of soaring prevalence of myopia, it is necessary to modify and cautiously popularize the techniques of episcleral pressurization of macula to provide high level clinical evidence for management of pathological myopia.
Posterior Scleral Reinforcement is an important surgical procedure for the treatment of pathological myopia. Currently used reinforcement materials mainly include biological materials such as allogeneic sclera, dura mater, and bovine pericardial patches, as well as non-biological materials such as polytetrafluoroethylene and silicone rubber devices. Allogeneic sclera and dura mater, as the most commonly used materials, have well-established surgical techniques but face source limitations, restricting their widespread clinical application. Bovine pericardial patches have improved mechanical properties through cross-linking treatment; perinatal tissues (umbilical cord/amnion) possess anti-inflammatory and regenerative characteristics; and novel biological materials such as silk fibroin hydrogels show potential in animal experiments but have not yet entered clinical validation. Among non-biological materials, expanded polytetrafluoroethylene is notable for promoting tissue integration, while adjustable silicone rubber devices offer new options for complex cases. However, existing materials still have limitations in terms of availability, long-term efficacy, and complications. Except for modified bovine pericardial patches and adjustable silicone rubber devices that have entered the clinical trial stage, most new materials remain in experimental research. Future efforts should strengthen material modification and clinical translation research to address the increasingly severe challenges in pathological myopia treatment.