Scleral strengthening treatment and its effect on the eyeball coats oxidative stress in progressive myopia

In patients with progressive myopia, there is an imbalance between the processes of lipid peroxidation and antioxidant protection, which is confirmed by changes in the level of hypoxia markers and the activity of the antioxidant enzyme superoxide dismutase (SOD) in the tear fluid (TF).

Purpose: to study the SOD activity in the TF of patients with moderate and high progressive myopia after sclera-strengthening treatment.

Material and methods. We examined 82 patients (82 eyes) aged 8 to 17 years with progressive myopia (ave 9.1 ± 0.3 D), divided into two main groups: in the 1st group (47 patients), minimally invasive scleroplasty (MIS) was performed using a biologically active graft, in the 2nd group (35 patients) — bandaging scleroplasty (BSP) according to the Snyder-Thompson technique using homoscleral graft. The control group consisted of 12 unoperated patients aged 7–13 years with low hyperopia (0.25 D to 1 D). At various times after MIS and BSP, SOD activity (by inhibition of quercetin autoxidation) and total protein concentration according to Lowry were determined.

Results. SOD activity in the TF before surgery in patients of group 1 (32.0 ± 5.3 U/mg protein) and group 2 (24.7 ± 6.4 U/mg protein) was in generally significantly higher than in the control group (20.0 ± 3.2 U/mg protein). At the same time, in some patients with initially low SOD values, enzyme activity significantly increased 1 month after surgery (p < 0.01) and exceeded the control level by 4.3–5.2 times. In case of initially elevated SOD activity, on the contrary, the enzyme concentration significantly decreased (p < 0.01) — 3.5 times with BSP and 1.9 times with MIS. After 6 months, in patients of the MIS group with the initial level of SOD activity below the norm, the enzyme activity remained 2 times higher than normal values (p < 0.01). All other patients showed a decrease in SOD values to the control level, and in some cases below it.

Conclusion. Sclero-strengthening treatment has a normalizing effect on SOD activity in the TF, which contributes to the correction of metabolic disorders caused by progressive myopia and confirms the importance of scleroplasty as a method activating bioregulation and normalizing oxidation-reduction processes in the eye tissues.

1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 May; 123 (5): 1036–42. doi: 10.1016/j.ophtha.2016.01.006

2. Avetisov E.S. Myopia. Moscow: Meditsina; 1999 (In Russ.).

3. Wojciechowski R. Nature and nurture: the complex genetics of myopia and refractive error. Clin Genet. 2011 Apr; 79 (4): 301–20. doi: 10.1111/j.1399-0004.2010.01592.x

4. Lin HJ, Wan L, Tsai Y, et al. Sclera-related gene polymorphisms in high myopia. Mol Vis. 2009 Aug 20; 15: 1655–63. PMID: 19710942.

5. Dunphy EB, Stoll MR, King SH. Myopia among American male graduate students. Am J Ophthalmol. 1968 Apr; 65 (4): 518–21. doi: 10.1016/0002-9394(68)93865-8

6. Mutti DO. Hereditary and environmental contributions to emmetropization and myopia. Optom Vis Sci. 2010 Apr; 87 (4): 255–9. doi: 10.1097/OPX.0b013e3181c95a24

7. Iomdina E.N. Biomechanical and biochemical disorders of the sclera in progressive myopia and methods of their correction. In: Avetisov S.E., Kashchenko T.P., Shamshinova A.M., eds. Visual functions and their correction in children. Moscow: Meditsina; 2005: 163–83 (In Russ.).

8. Xiao Q, Zhang X, Chen ZL, Zou YY, Tang CF. An Evidence-based narrative review of scleral hypoxia theory in myopia: From mechanisms to treatments. Int J Mol Sci. 2025 Jan 2; 26 (1): 332. doi: 10.3390/ijms26010332

9. Morgan IG. The biological basis of myopic refractive error. Clin Exp Optom. 2003 Sep; 86 (5): 276–88. doi: 10.1111/j.1444-0938.2003.tb03123.x

10. Shkrebets G.V. Biochemical indices and prognosis of glaucoma development in patients with progressive myopia. Vestnik oftal’mologii. 2010; 126 (5): 17–9 (In Russ.). https://pubmed.ncbi.nlm.nih.gov/21328885/

11. Zborovskaya I.A., Bannikova M.V. Antioxidant system of the body, its importance in metabolism. Clinical aspects. Bulletin of the Russian Academy of Medical Sciences. 1995; 6: 53–60 (In Russ.).

12. Iomdina E.N., Tarutta E.P., Markosian G.A., Gavrilova J.I. Current assessment results of the efficacy and safety of scleroplasty in progressive myopia. Russian ophthalmological journal. 2021; 14 (1): 96–103 (In Russ.). https://doi.org/10.21516/2072-0076-2021-14-1-96-103

13. Tarutta E.P., Iomdina E.N., Kruzhkova G.V., Markosyan G.A. Remote results of sclero-reconstructive treatment of progressive myopia. Russian ophthalmological journal. 2011; 4 (1): 71–5 (In Russ.).

14. Kostiuk V.A., Potapovich A.I., Kovaleva Zh.V. A simple and sensitive method of determination of superoxide dismutase activity based on the reaction of quercetin oxidation. Voprosy meditsinskoi khimii. 1990; 2: 88–91 (In Russ.).

15. Menshchikova E.B., Lankin V.Z., Zenkov N.K., et al. Oxidative stress. Prooxidants and antio xidants. Moscow: Firma Slovo, 2006 (In Russ.).

16. Avetisov E.S., Stishkovskaya N.N. Combined method of improving eye hemodynamics. Methodical recommendations. Moscow; 1980 (In Russ.).

17. Iomdina E.N., Tarutta E.P., Markossian G.A., et al. Transpalpebral rheoophthalmography as a method for evaluating the effectiveness of sclera-strengthening and trophic treatment of progressive myopia. Ophthalmology in Russia. 2018; 15 (4): 439–46 (In Russ.). https://doi.org/10.18008/1816-5095-2018-4-439-446

18. Andreeva L.D., Iomdina E.N., Tarutta E.P., et al. Experimental and morphological study of the results of scleroplasty with a biologically active transplant. Bulletin of the Smolensk State Medical Academy. 2005; 2: 33–6 (In Russ.). https://cyberleninka.ru/article/n/eksperimentalno-morfologicheskoe-izuchenie-rezultatov-skleroplastikibiologicheski-aktivnym-transplantatom

19. Tarutta E.P., Maksimova M.V., Shengelaya V.G. Hemodynamics in patients with myopia after various scleral strengthening interventions. In: Pathology of the fundus and optic nerve. Moscow; 1991: 101–6 (In Russ.).

20. Wei YH, Lee HC. Oxidative stress, mitochondrial DNA mutation, and impairment of antioxidant enzymes in aging. Exp Biol Med (Maywood). 2002 Oct; 227 (9): 671–82. doi: 10.1177/153537020222700901