Prospective possibilities for assessing the impact of scleroplasty in high myopia on ocular hemodynamics

Purpose of the study was to evaluate changes in choroidal thickness (CT) and hemodynamics parameters in patients with high progressive myopia before and after banding scleroplasty (BSP) using optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG). Material and methods. The study included 42 patients (42 eyes) aged 13.0 ± 1.8 years with high progressive myopia, which according to the spherical equivalent (SE) averaged 10.4 ± 3.3 D, and the axial length (AL) equal to an average of 27.6 ± 1.6 mm. BSP was performed using a modified Snyder – Thompson technique in our own modification. CT was measured on a multimodal SLO/OCT Mirante multimodal platform (Nidek, Japan). Blood flow in the macular area was assessed using the LSFG-RetFlow instrument (Nidek, Japan) with the determination of the mean blur rate (MBR). Results. One month after surgery, a statistically significant increase in TC was detected in the center of the macular zone compared to the baseline level by 34.6 μm (p ≤ 0.05), after 6 months by 18.8 μm, and after 12 months by 11.8 μm. According to LSFG data, a trend towards an increasing in choroidal blood flow was noted after BSP, which by the end of the observation period amounted to 20.4% . A correlation between the dynamics of choroidal blood filling intensity and blood flow velocity was determined only 1 month after BSP, which was confirmed by a parallel increase in TC by 17.6% and an increase in MBR by 10.9%. However, subsequently (after 6 and 12 months), the former indicator decreased, while the latter maintained an upward trend. Conclusion. The use of OCT and LSFG methods allowed us to establish a relationship between changes in choroidal blood filling (TC) and blood flow velocity (MBR). The obtained results clarify the mechanisms of the stimulating effect of BSP on choroidal microcirculation in patients with high myopia.

1. Du R, Xie S., Igarashi-Yokoi T., et al. Continued increase of axial length and its risk factors in adults with high myopia. JAMA Ophthalmol. 2021; 139 (10): 1096–103. doi: 10.1001/jamaophthalmol.2021.3303

2. Qi ZY, Chen J, He XG. Epidemiology of high myopia among children and adolescents in China. Zhonghua Yan Ke Za Zhi. 2023; 59 (2): 138–45. doi: 10.3760/cma.j.cn112142-20220313-00105

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

4. Li SM, Liu LR, Li SY, et al. Annual incidences and progressions of myopia and high myopia in Chinese schoolchildren based on a 5-year cohort study. Invest Ophthalmol Vis Sci. 2022; 63 (1): 8. doi: 10.1167/iovs.63.1.8

5. Shah R, Vlasak N, Evans BJW. High myopia: reviews of myopia control strategies and myopia complications. Ophthalmic Physiol Opt. 2024; 44 (7): 1248–60. doi: 10.1111/opo.13366

6. Tarutta E.P. Complicated myopia: congenital and acquired. Visual functions and their correction in children. Moscow: Meditsina; 2005: 137–59 (In Russ.).

7. Chen CA, Lin PY, Wu PC. Treatment effect of posterior scleral reinforcement on controlling myopia progression: a systematic review and meta-analysis. PLoS One. 2020; 15 (5): e0233564. doi: 10.1371/journal.pone.0233564

8. Jonas JB, Ang M, Cho P, et al. IMI prevention of myopia and its progression. Invest Ophthalmol Vis Sci. 2021; 62 (5): 6. doi: 10.1167/iovs.62.5.6

9. Li Y, Zhou Y, Wang C, et al. Advances in OCT imaging in myopia and pathologic myopia. Diagnostics (Basel). 2022; 12 (6): 1418. doi: 10.3390/diagnostics12061418

10. Liu XJ, Li ZH, Guo WY, et al. Structure characterization and performance evaluation of genipin-modified bovine pericardial scleral biological patch. China J Tissue Eng Res. 2022; 26 (34): 5430–5.

11. Tarutta E.P. Surgical prevention of myopia progression. Indications and methods. Refraktsionnaya khirurgiya i oftal'mologiya. 2002; (3): 29–32 (In Russ.).

12. Tarutta E.P. Pathogenetically based system of diagnosis, prognosis, prevention and sclero-reconstructive treatment of pathological myopia. Russian pediatric ophthalmology. 2008; 1: 25–7 (In Russ.).

13. Ma J, Wang Q, Li Y, et al. Biomechanical considerations of patching material for posterior scleral reinforcement surgery. Front Med (Lausanne). 2022; 9: 888542. doi: 10.3389/fmed.2022.888542

14. Svirin A.V., Antipova O.A., Serebryakova T.V. Modification of the operation of introducing homogenous tissue suspension into the Tenon's space in high progressive myopia. Vestnik oftal'mologii. 1984; 4: 31–3 (In Russ.).

15. Tarutta E.P. Choice of scleroplasty method for progressive myopia in children. Vestnik oftal'mologii. 1992; (2): 10–3 (In Russ.).

16. Bochkareva Z.G., Libman E.S., Belyaev V.S., Melkumyants T.A. Clinical and functional state of eyes with high complicated myopia after scleroplasty. Vestnik oftal'mologii. 1980; 6: 32–6 (In Russ.).

17. Peng C, Chen Y, Li W, et al. Effects of posterior scleral reinforcement in pathological myopia: a 3-year follow-up study. Graefes Arch Clin Exp Ophthalmol. 2019; 257 (3): 607–17. doi: 10.1007/s00417-018-04212-y

18. Li XJ, Yang XP, Li QM, et al. Posterior scleral reinforcement for the treatment of pathological myopia. Int J Ophthalmol. 2016; 9 (4): 580–4. doi: 10.18240/ijo.2016.04.18

19. Ucak T, Icel E, Yilmaz H., et al. Alterations in optical coherence tomography angiography findings in patients with high myopia. Eye (Lond). 2020; 34 (6): 1129–35. doi: 10.1038/s41433-020-0824-1

20. Tarutta E.P., Kondratova S.E., Milash S.V. Early changes in choroidal thickness and axial eye length with the use of spectacles with monofocal lenses and highly aspherical microlenses in children with newly diagnosed myopia. Vestnik oftal'mologii. 2024; 140 (5): 18–24 (In Russ.). doi: 10.17116/oftalma202414005118

21. Hanazaki H, Yokota H, Aso H, et al. Evaluation of ocular blood flow over time in a treated retinal arterial macroaneurysm using laser speckle flowgraphy. Am J Ophthalmol Case Rep. 2021; 21: 101022. doi: 10.1016/j.ajoc.2021.101022

22. Anraku A, Enomoto N, Tomita G, et al. Ocular and systemic factors affecting laser speckle flowgraphy measurements in the optic nerve head. Transl Vis Sci Technol. 2021; 10 (1): 13. doi: 10.1167/tvst.10.1.13

23. Matsumoto M, Suzuma K, Akiyama F, et al. Retinal microvascular resistance estimated from waveform analysis is significantly higher with a threshold value in central retinal vein occlusion. Transl Vis Sci Technol. 2020; 9 (11): 4. doi: 10.1167/tvst.9.11.4

24. Matsumoto M, Suzuma K, Yamada Y, et al. Retinal blood flow after intravitreal bevacizumab is a predictive factor for outcomes of macular edema associated with central retinal vein occlusion. Retina. 2018; 38 (2): 283–91. doi: 10.1097/IAE.0000000000001531

25. Yamazaki R, Hashimoto R, Masahara H, et al. Time course in ocular blood flow and pulse waveform in a case of ocular ischemic syndrome with intraocular pressure fluctuation. Vision (Basel). 2020; 4 (2): 31. doi: 10.3390/vision4020031

26. Iwase T, Mikoshiba Y, Yamamoto K, et al. Evaluation of blood flow on optic nerve head after pattern scan and conventional laser panretinal photocoagulation. Medicine (Baltimore). 2019; 98 (24): e16062. doi: 10.1097/MD.0000000000016062

27. Xie R, Qiu B, Chhablani J, Zhang X. Evaluation of choroidal thickness using optical coherent tomography: A review. Front Med (Lausanne). 2021; 8: 783519. doi: 10.3389/fmed.2021.783519

28. Deng J, Jin J, Zhang B, et al. Effect of ocular magnification on macular choroidal thickness measurements made using optical coherence tomography in children. Curr Eye Res. 2022; 47 (11): 1538–46. doi: 10.1080/02713683.2022.2119255

29. Jiang Z, Lin T, Lin A, et al. Coefficient of spatial variance of choroidal thickness on swept-source optical coherence tomography in healthy eyes. Int Ophthalmol. 2024; 44 (1): 318. doi: 10.1007/s10792-024-03218-2

30. Astrakhov Yu.S., Belekhova S.G. Choroidal thickness in myopia of varying degrees. Oftal'mologicheskie vedomosti. 2013; 6 (4): 34–8 (In Russ.).

31. Avetisov S.E., Budzinskaya M.V., Zhabina O.A., et al. Analysis of changes in the central fundus zone in myopia according to fluorescein angiography and optical coherence tomography. Vestnik oftal'mologii. 2015; 131 (4): 38–48 (In Russ.).

32. Egorov E.A., Eskina E.N., Gvetadze A.A., et al. Morphometric features of the eyeball in patients with myopia and their impact on visual functions. RMJ. Clinical ophthalmology. 2015; 15 (4): 186–90 (In Russ.).

33. Kornilovskiy I.M. Pathogenetic aspects of myopia stabilization after scleroplastic operations. Oftal'mologicheskiy zhurnal. 1987; 6: 343–7 (In Russ.).

34. Mirzayants M.G., Pristavko E.F., Pivovarova N.N. On the mechanisms of the therapeutic action of scleral strengthening surgery. In: Reconstructive ophthalmic surgery. Moscow; 1979: 136–8 (In Russ.).

35. Zaykova M.V., Negoda V.I. Homoscleral transplantation in progressive myopia. Vestnik oftal'mologii. 1970; (4): 16–20 (In Russ.).

36. Tarutta E.P., Markosyan G.A., Sianosyan A.A., Milash S.V. Choroidal thickness in children with myopia and its changes after surgical scleral reinforcement. Vestnik oftal'mologii. 2020; 136 (3): 10–7 (In Russ.). doi: 10.17116/oftalma202013603110

37. Miura M, Arimoto G, Tsukahara R, et al. Choroidal thickness after scleral buckling. Ophthalmologe. 2014; 111 (10): 954–60. doi: 10.1007/s00347-013-2978-8

38. Mo J, Duan A, Chan S, et al. Application of optical coherence tomography angiography in assessment of posterior scleral reinforcement for pathologic myopia. Int J Ophthalmol. 2016; 9 (12): 1761–5. doi: 10.18240/ijo.2016.12.10

39. Devarajan K, Sim R, Chua J, et al. Optical coherence tomography angiography for the assessment of choroidal vasculature in high myopia. Br J Ophthalmol. 2020; 104 (7): 917–23. doi: 10.1136/bjophthalmol-2019-314769

40. Xiong K, Wang F, Yang Y, et al. Influence of high myopia on choriocapillaris perfusion and choroidal thickness in diabetic patients without diabetic retinopathy. Retina. 2022; 42 (6): 1077–84. doi: 10.1097/IAE.0000000000003427

41. Swiatczak B, Schaeffel F, Calzetti G. Imposed positive defocus changes choroidal blood flow in young human subjects. Graefes Arch Clin Exp Ophthalmol. 2023; 261 (1): 115–25. doi: 10.1007/s00417-022-05842-z

42. Lu Y, Zhou H, Zhou X, et al. Correlation between Laser Speckle Flowgraphy and OCT-derived retinal and choroidal metrics in healthy human eye. Transl Vis Sci Technol. 2022; 11 (6): 15. doi: 10.1167/tvst.11.6.15