Aims: This study aimed to explore ocular and systemic factors associated with pathologic myopia in patients with high myopia and develop predictive models for differentiating between simple high myopia and pathologic myopia, particularly in its early stage.
Methods: This cross-sectional study was conducted on 2767 patients with bilateral high myopia at baseline follow-up. Demographic, ocular biometric and clinical data were collected, including age, corrected distance visual acuity, axial length (AL), spherical equivalent (SE), myopic atrophy maculopathy (MAM) grading based on the International Meta-Analysis for Pathologic Myopia criteria and ocular and systemic comorbidities. Multimodal imaging techniques were employed to assess plus lesions and posterior staphyloma. Logistic regression was used to identify associated factors and develop predictive models.
Results: Among all patients, 1697 (61.33%) were classified as having pathologic myopia. Its prevalence increased with longer AL and more severe SE. Significant ocular comorbid associated factors included cataract, epiretinal membrane, foveoschisis, full-thickness macular hole, retinal detachment and strabismus, and hypertension was the only systemic associated factor identified. Predictive models for differentiating simple high myopia and pathologic myopia, MAM categories 1 and 2, achieved area under the curve values up to 0.978 and 0.964, respectively.
Conclusion: This study underscores the high prevalence of pathologic myopia in a highly myopic population and identifies ocular and systemic associated factors for pathologic myopia. The developed predictive models provide valuable tools for distinguishing between simple high myopia and pathologic myopia, facilitating early diagnosis and management.
Purpose: To compare the outcomes of scleral-fixated intraocular lenses (SFIOLs) in the paediatric population. We included sutureless scleral-fixated intraocular lenses (SLSFIOLs), glued scleral-fixated intraocular lenses (GSFIOLs) and sutured scleral-fixated intraocular lenses (SSFIOLs) using polypropylene and Gore-Tex sutures.
Methods: A systematic review and meta-analysis were performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was performed to include studies from 1999 to 2023. We included 1-18-year-old studies. The analysis was based on fixed and random-effect models. Primary outcomes included visual acuity, refraction and intraocular pressure (IOP). Secondary outcomes were lens tilt and extrusion of suture material.
Results: 33 studies (1531 eyes) were included (GSFIOLs n=75, SLSFIOLs n=162, SSFIOLs n=1294 (Gore-Tex n=30 and polypropylene n=1264)). Vision improved from preoperative (mean 0.75±0.50 SD) to postoperative (mean 0.39±0.19 SD) logarithm of the minimal angle of resolution. The mean spherical equivalent was 0.59±0.91. Transient high IOP post-OP was highest among polypropylene SSFIOLs, 8.1%. Polypropylene SSFIOLs had glaucoma in 0.31% and corneal decompensation in 0.15%. A suture break or erosion was reported in 1.19%. None of the other groups developed glaucoma or corneal decompensation. Suture erosion was not reported in Gore-Tex SSFIOLs. GSFIOLs had a 5.3% reoperation rate, mostly for IOL repositioning.
Conclusion: All types of scleral lens fixation showed improvement in initial outcomes. SLSFIOLs and Gore-Tex SSFIOLs have low complication rates.
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