Sir,

We read with great interest the article titled ‘The efficacy and safety of posterior pole buckles in the control of progressive high myopia’ by Ward et al,1 which appeared in the 2009 issue of Eye.

We would like to mention the experience in 183 patients (86.33% unilateral and 13.66% bilateral) who underwent scleroplasty for progressive myopia after a period of up to 10 years (median 8 years) at Fyodorov Eye Center (Moscow, Russia).

Homologous sclera was used as graft for scleroplasty. A strip 8–9 mm wide and 7–8 cm long was excised from the sclera. The conjunctiva and Tenon's capsule were incised. Tendons of the superior, lateral, and inferior rectus muscles, as well as the inferior oblique muscle were isolated. Then, one end of the scleral flap was passed under the superior rectus and secured by two sutures, and then the free end of the transplant was passed under the lateral rectus, inferior oblique, and inferior rectus muscles. The next stage of the operation consisted of shifting the scleral flap from the equator of the eye to the posterior pole. The transplant was stretched until the surgeon felt that it had settled on the posterior pole of the eye. The inferior end of the scleral flap was fastened by two sutures.

Examination showed that the progression of myopia was arrested in 95% of cases.

Stabilization of the process was determined by the refraction and axial length of the eye. Refraction decreased by 0.5–3.0 D (mean 1.3 D) in 61.5% of the cases in the early postoperative period. A-mode ultrasonography was used for axial length measurements. The range of pre-operative axial length was 26.5–35.2 mm (median 31.8 mm). The axial length of the eye shortened by 0.1–2.5 mm (mean 0.5 mm) in the early postoperative period in 35.4% of the cases and by 0.98 mm at a later period in 48.6% of the cases. The decrease in these parameters immediately after the operation may be explained by the fact that the transplant had stretched the sclera of the myopic eye, while over a long-term period this effect must have been intensified as a result of sclera cicatrization at the site of its contact with the transplant.

The following indications for scleroplasty operation were considered:

  1. 1)

    A rapid progression of myopia from 5.0 to 6.0 D and its increase by at least 1.0 D per year; augmentation of dystrophic changes in the fundus; and the resultant deterioration in visual acuity.

  2. 2)

    An increase in dystrophic changes in the retina and vitreous body, even when there was no increase in the degree of myopia.

Contraindications for surgery were acute and chronic inflammatory diseases of the eye and lacrimal ducts, neoplasm, and pathological exophthalmia.

The postoperative complications were separation of sutures, elevated IOP, and iridocyclitis in 5% of the patients.

It might be appropriate to recommend a larger prospective, randomized, clinical trial study to determine a possible therapeutic role for this treatment.