Posterior sclera reinforcement (PSR) has been developed for more than 60 years. Unfortunately, its clinical efficacy hasn′t gained wide recognition even recently. The literatures about treating high myopia with PSR were searched in Pubmed, CNKI and VIP from 1965/01/01 to 2015/11/30 with the key words ″scleroplasty″, ″scleral reinforcement″ and ″high myopia″, among which the language categories, the number of the literatures in different time periods, the operation style, reinforcement materials and efficacy of PSR were analyzed. PSR was mainly carried out in Russia, Eastern Europe and China. The numbers of articles published on PSR gradually increased from the 1970 s, to reach the top in the mid of 1980 s, and gradually decreased after that time in Non-Chinese literatures. The first Chinese paper reported about PSR was published in the mid of 1980 s, the numbers of publication increased gradually. There is steady incrase in publication of PSR over last 15 years. The efficacy of PSR is still under controversial since too many operation styles and materials were chosen and lack of universal standards, most of which can′t meet the mechanical requirements of reinforcement. The number of Chinese literatures began to rebound in the new century. With the development of the new surgical techniques by our group and innovation of new reinforcement materials, PSR could be expected to gain the popularity in the new century for the treatment of retinopathy in highly myopic patients again.

后巩膜加固术作为控制高度近视进展的手术，在临床的开展已有60多年历史，但尚未在临床得到广泛认同。美国国家医学图书馆（Pubmed）、中文科技期刊全文数据库（CNKI）和维普知识资源系统（VIP）上不同时期后巩膜加固术治疗高度近视相关文献发表情况表明，后巩膜加固术术式多样，加固材料种类驳杂，临床疗效存在争议。后巩膜加固术相关文献发表的数量，国外文献以俄文和东欧语居多，自20世纪70年代开始逐渐增多，到20世纪80年代中期后达到高峰，此后逐渐减少；国内自20世纪80年代中期开始逐渐上升，至上世纪末达到高峰，之后逐渐减少，进入新世纪以来，再次出现增长趋势。后巩膜加固术式和材料存在缺陷，临床没有标准，难以达到手术机制的要求，是影响手术疗效，不被临床广泛认同和开展的主要原因。后巩膜加固术相关文献发表数量的变化，反映了该手术在临床开展起伏的历史状况，后巩膜加固术曾在俄罗斯、东欧及中国等地区有较多开展，目前国外临床已较少开展，而在中国新一轮的临床探索正悄然开始。

With the rapid development of modern 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.

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。

Posterior sclera reinforcement (PSR) has been developed for more than 60 years. Unfortunately, its clinical efficacy hasn′t gained wide recognition even recently. The literatures about treating high myopia with PSR were searched in Pubmed, CNKI and VIP from 1965/01/01 to 2015/11/30 with the key words ″scleroplasty″, ″scleral reinforcement″ and ″high myopia″, among which the language categories, the number of the literatures in different time periods, the operation style, reinforcement materials and efficacy of PSR were analyzed. PSR was mainly carried out in Russia, Eastern Europe and China. The numbers of articles published on PSR gradually increased from the 1970 s, to reach the top in the mid of 1980 s, and gradually decreased after that time in Non-Chinese literatures. The first Chinese paper reported about PSR was published in the mid of 1980 s, the numbers of publication increased gradually. There is steady incrase in publication of PSR over last 15 years. The efficacy of PSR is still under controversial since too many operation styles and materials were chosen and lack of universal standards, most of which can′t meet the mechanical requirements of reinforcement. The number of Chinese literatures began to rebound in the new century. With the development of the new surgical techniques by our group and innovation of new reinforcement materials, PSR could be expected to gain the popularity in the new century for the treatment of retinopathy in highly myopic patients again.

后巩膜加固术作为控制高度近视进展的手术，在临床的开展已有60多年历史，但尚未在临床得到广泛认同。美国国家医学图书馆（Pubmed）、中文科技期刊全文数据库（CNKI）和维普知识资源系统（VIP）上不同时期后巩膜加固术治疗高度近视相关文献发表情况表明，后巩膜加固术术式多样，加固材料种类驳杂，临床疗效存在争议。后巩膜加固术相关文献发表的数量，国外文献以俄文和东欧语居多，自20世纪70年代开始逐渐增多，到20世纪80年代中期后达到高峰，此后逐渐减少；国内自20世纪80年代中期开始逐渐上升，至上世纪末达到高峰，之后逐渐减少，进入新世纪以来，再次出现增长趋势。后巩膜加固术式和材料存在缺陷，临床没有标准，难以达到手术机制的要求，是影响手术疗效，不被临床广泛认同和开展的主要原因。后巩膜加固术相关文献发表数量的变化，反映了该手术在临床开展起伏的历史状况，后巩膜加固术曾在俄罗斯、东欧及中国等地区有较多开展，目前国外临床已较少开展，而在中国新一轮的临床探索正悄然开始。

Objective To examine choroidal thickness and its relationship with axial length and spherical equivalence using spectral domain optical coherence tomography (SD-OCT) in patients with high myopic foveoschisis (MF). Methods Twenty-five patients with MF were prospectively recruited in the Beijing Jingmei Group General Hospital from November 2014 to February 2016. Fifty eyes of 50 age- and sex-matched people were used as controls. SD-OCT was used to measure choroidal thickness subfoveally and at 1.5 mm superiorly, inferiorly, nasally and temporally. A paired t test was used to assess the difference in spherical equivalence, axial length and choroidal thickness between the MF group and the controls. Logistic regression analysis was performed to evaluate the correlation between age, spherical equivalence, axial length, choroidal thickness and MF. Results The differences in spherical equivalence and axial length between the MF group and controls were not statistically significant (P＞0.05). Choroidal thicknesses subfoveally and at 1.5 mm superiorly, inferiorly, nasally and temporally were greater in the controls than in the MF eyes (t=24.131, 20.345, 16.140, 13.923, 19.037, P

目的 采用频域光学相干断层扫描（SD-OCT）测量和分析病理性近视黄斑劈裂（MF）患者的黄斑区脉络膜厚度并探讨MF相关的影响因素。方法 横断面研究。选取2014年11月至2016年2月于北京京煤集团总医院确诊为单眼MF的患者25例（MF组），同期选取50例（50眼）年龄、性别匹配的正常成年人为对照组。采用SD-OCT，分别对黄斑中心凹下及其上方、下方、鼻侧、颞侧各1.5 mm处的脉络膜厚度进行测量。采用t检验、logistic回归进行数据分析。结果 MF患眼与对侧眼相比，眼轴长度、等效球镜度差异均无统计学意义。对照组黄斑中心凹下及其上方、下方、鼻侧、颞侧各1.5 mm处的脉络膜厚度均大于MF眼（t=24.131、20.345、16.140、13.923、19.037，P

Objective To evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients. Methods A prospective study was conducted, in which 36 pathological myopia patients（36 eyes）with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes) voluntarily underwent posterior scleral reinforcement (PSR, operation group) and 12 patients (12 eyes) didn′t receive operation (control group) .There are no statistical differences (P＞0.05) in age, gender, length of axis oculi, spherical equivalent between the 2 groups. All patients were examined by best corrected visual acuity (BCVA), macular retinoschisis types, central foveal thickness (CFT), maximum foveal thickness (MxFT) . Patients in operation group were scheduled to a follow-up 3rd, 6th, and 9th month after surgery respectively. Patients in control group all were followed up once every three months. A contrast observation was made on the changes of BCVA, CFT, MxFT, findings of the foveoschisis and the complications of the surgery between groups. Results Compared with the preoperation after 9 month follow-up: in the operation group, the BCVA was significantly increased postoperatively (Z=-3.43, P=0.01), the mean CFT was significantly decreased postoperatively (Z=-2.71, P=0.007)，while the MxFT which was not significantly decreased postoperatively (Z=-0.67, P=0.503). In the control group, there was no significant change in BCVA (Z=-1.840, P＞0.05), the CFT and the MxFT were signi?cant increased respectively (Z=-2.803, -2.04;P＜0.05). In the operation group, there were 6 (25.0%) of the 24 eyes get complete resolution of the foveoschisis; 16 (66.7%) of them is not completely attached however the retinoschisis was significantly decreased; only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased. In the control group no one get complete resolution of the myopic foveoschisis, and 2 eyes developed to retinal detachment in 6 and 8 month respectively. There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis, vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery. Conclusions Posterior scleral reinforcement surgery was found effective in improving the visual acuity, reducing the CFT. No obvious complications were found during and after the surgery.

目的 观察后巩膜加固手术治疗病理性近视黄斑劈裂（MF）的临床效果。 方法 前瞻性临床研究。临床确诊为MF的36例患者36只眼纳入研究。自愿接受后巩膜加固手术治疗者24例24只眼作为手术组；同意定期随访，但不愿意接受手术治疗者12例12只眼作为对照组。两组患者年龄、性别、眼轴长度、等效球镜度数、最佳矫正视力（BCVA）、黄斑劈裂类型、黄斑中心凹视网膜劈裂高度（CFT）、劈裂最高值（MxFT）比较，差异均无统计学意义（ P ＞0.05）。手术组患眼治疗后3、6、9个月时随访；对照组患眼首诊后每隔3个月随访。均随访9个月。对比观察患眼BCVA、CFT和MxFT变化以及视网膜复位情况。同时观察手术组患眼并发症发生情况。 结果 手术组24只眼中，劈裂腔消失、视网膜完全复位6只眼，占25.0%；劈裂腔隙不同程度缩小、视网膜层间积液吸收、视网膜部分复位16只眼，占66.7%；视网膜未复位2只眼，占8.3%。视网膜未复位2只眼分别表现为黄斑裂孔、劈裂腔高度增加。对照组12只眼视网膜均未复位，其中2只眼在随访后第6、8个月时出现黄斑裂孔性视网膜脱离，占16.7%。与治疗前比较，手术组患眼治疗后BCVA（ Z =-3.430）明显提高，CFT（ Z =-2.707）明显降低，差异均有统计学意义（ P ＜0.05）；MxFT无明显变化，差异无统计学意义（ Z =-0.670， P ＞0.05）。与首诊时比较，对照组患眼随访第9个月时BCVA无明显变化，差异无统计学意义（ Z =-1.840， P ＞0.05）；CFT、MxFT均明显提高，差异有统计学意义（ Z =-2.803、-2.040， P ＜0.05）。手术组患眼均未发生眼压增高、眼底出血、黄斑前膜、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。 结论 后巩膜加固手术治疗MF，可提高患眼视力，降低CFT；未见手术相关并发症发生。

Objective To objectively quantitative assess the visual quality in patients with myopic foveoschisis (MF) using a double-pass optical quality analysis system (OQASⅡ). Methods Sixty-two subjects participated in this cross-sectional, observational study, who were divided into three groups based on the pathologic conditions including myopic foveoschisis group (MFG), myopic control group (MCG) and normal control group (NCG). Measurements with OQAS Ⅱ were performed for the modulation transfer function cut off frequency (MTF cut-off), the Strehl ratio (SR) and the objective scatter index (OSI). Visual data were analyzed using ANOVA and Pearson′s correlation accompanied by logMAR BCVA and axial length (AL). Results The mean values for MTF cut-off, SR and OSI of MFG, MCG and NCG were 18.18±4.81, 0.13±0.03, 3.50±0.44; 22.87±2.66, 0.14±0.02, 2.42±0.29; 33.68±4.70, 0.23±0.02, 1.68±0.20 respectively, and statistical difference were proved except SR between MFG and MCG, or BCVA between MCG and NCG (P＜0.05). LogMAR BCVA and AL have negative correlations to MTF cut-off (r=-0.928, -0.658; P＜0.05) and SR (r=-0.577, -0.893; P＜0.05) with high coefficients in MFG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.659, -0.806; P＜0.05) in MCG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.606, -0.602; P＜0.05) and positively correlated to OSI (r=0.561, P＜0.05) in NCG. Conclusions The mean value of BCVA, MTF cut-off, SR, OSI of myopic foveoschisis patients were lower than those myopic patients without foveoschisis and normal people. there exists a significant negative correlation between Log MAR BCVA, AL to MTF cut-off and SR. Compared with myopic and normal subjects, myopic foveoschisis have lower BCVA, MTF cut-off, SR but higher OSI.

目的 客观定量评估高度近视黄斑劈裂（MF）患者的视觉质量。 方法 横断面研究。临床检查确诊的高度近视黄斑劈裂（MF）患者19例19只眼（近视劈裂组）、无黄斑劈裂高度近视21例21只眼（近视对照组）及无高度近视正常者22名22只眼（正常对照组）纳入研究。所有受检者均行医学验光、最佳矫正视力（BCVA）检查以及眼轴长度（AL）测量。采用双通道视觉质量分析系统（OQASⅡ）测量受检眼调制传递函数截止频率（MTF out-off）、斯特列尔比（SR）、客观散射指数（OSI）。采用Pearson分析最小分辨角对数（logMAR） BCVA、AL与MTF cut-off、SR、OSI之间的相关性。 结果 近视劈裂组、近视对照组、正常对照组受检眼平均MTF cut-off、SR、OSI值比较，差异均有统计学意义（F=76.00、116.15、165.77，P＜0.05）。两两比较，近视劈裂组与近视对照组受检眼SR平均值差异无统计学意义（P＞0.05）；其余任意两组间MTF cut-off、SR、OSI值差异有统计学意义（P＜0.05）。近视劈裂组患眼logMAR BCVA、AL分别与MTF cut-off（r=-0.928、-0.658，P＜0.05）、SR呈负相关（r=-0.577、-0.893，P＜0.05）；近视对照组患眼logMAR BCVA与MTF cut-off、SR呈负相关（r=-0.659、-0.806，P＜0.05）；正常对照组受检眼logMAR BCVA与MTF cut-off、SR呈负相关（r=-0.606、-0.602，P＜0.05），与OSI呈正相关（r=0.561，P＜0.05）。 结论 MF患者BCVA、MTF cut-off、SR、OSI值均低于无劈裂近视患者及正常人群；BCVA、AL与MTF cut-off、SR值之间呈负相关；BCVA、MTF cut-off、SR值在正常人群、无劈裂高度近视人群和MF患者中依次降低，OSI值逐渐增加。