Efficacy of posterior scleral reinforcement in the management of myopic traction maculopathy: a single-arm retrospective study.

backgroundMyopic traction maculopathy (MTM) is a condition characterized by retinal complications due to excessive axial elongation in myopic eyes. Posterior scleral reinforcement (PSR) stabilizes the posterior pole by mechanically supporting the thinned sclera, limiting further axial elongation, and reducing macular traction. This study evaluates the efficacy of PSR in patients diagnosed with MTM.

methodsThis study included patients with myopic traction maculopathy (MTM) who underwent posterior scleral reinforcement (PSR) between September 2020 and February 2023. Inclusion criteria were high myopia (HM; spherical equivalent [SE] ≤ - 6.00 diopters [D] or axial length [AL] ≥ 26 mm) with documented progression ( ≥ - 1.00 D/year or > 0.5 mm/year) and optical coherence tomography (OCT)‑confirmed myopic retinoschisis, macular hole, or macular detachment (MD). Exclusion criteria included prior refractive surgery, significant lens opacity, glaucoma, ocular trauma, or other vision‑threatening retinal diseases. Pre‑ and postoperative evaluations included best‑corrected visual acuity (BCVA), SE, AL, retinal thickness (RT), and choroidal thickness (CT) measured by OCT. PSR was performed using a bovine pericardium graft placed along the posterior sclera without pars plana vitrectomy (PPV).

resultsThis single-arm retrospective study included 19 patients (21 eyes) with a mean follow-up of 7.43 ± 5.35 months. Preoperatively, the mean AL was 29.86 ± 2.24 mm, the mean SE was - 12.43 ± 7.83 D, the mean BCVA was 0.39 ± 0.29, and the mean CT was 79.71 ± 14.71 μm. At 6 months postoperatively, significant improvements were observed in BCVA (P < 0.05) and AL (P < 0.001), with AL demonstrating a statistically significant reduction from baseline. Additionally, CT increased by an average of 5.33 ± 11.29 μm (P < 0.05). RT measurements showed a reduction across all regions, with the nasal sector reaching statistical significance (P < 0.05). No significant changes were noted between 1 and 6 months in AL, SE, BCVA, or CT (P > 0.05). At the extended follow-up of 12 and 18 months, anatomical and functional outcomes remained stable compared with the 6-month results, with no additional postoperative complications detected. The beneficial effects of PSR on axial length stabilization and choroidal thickening were maintained for up to 18 months without further progression or deterioration.

conclusionsPSR may help reduce posterior pole traction in MTM and is associated with both anatomical and functional improvements, including better BCVA and favorable changes in AL, SE, CT, and RT. Future studies with larger sample sizes and prospective, controlled designs are warranted to validate these findings and assess the long‑term durability of PSR.