Observation of the effect of posterior scleral reinforcement combined with orthokeratology and 0.01% atropine in the treatment of congenital myopia: a case report
Authors: yan chunxiao , Liu Xiaoyu , Yu Taorui , Gao Shang , Mu Yanan , Zhao Fangkun , Xu Jun , Zhang Lijun 
Published: July 2023

Background
Myopia has recently emerged as a significant threat to global public health. The increasing prevalence of myopia among younger age groups has profoundly impacted the visual health of children and adolescents. Therefore, early intervention is crucial in preventing the development of high and pathological myopia in this age group, as these conditions can result in irreversible damage to eye tissues and severe impairment of visual function, placing a heavy burden on individuals, families, and society. Posterior scleral reinforcement (PSR) can effectively control the progression of high myopia. The reinforcing material can limit posterior scleral expansion, enhance scleral resistance to deformation, and improve retrobulbar vascular perfusion, thereby stabilizing the axial length and refraction of the eye. Orthokeratology and low concentrations of atropine are effective in slowing myopia progression. In this report, we present the case of a 3-year-old child with congenital myopia who underwent bilateral posterior scleral reinforcement and received postoperative treatment combining orthokeratology and 0.01% atropine to control myopia progression for up to 8 years.
Case presentation:
A female child was diagnosed with binocular congenital myopia and amblyopia at the age of 3. The right eye had an uncorrected visual acuity (UCVA) of 20/160, while the left had a UCVA of 20/200. Objective refraction measurement was − 7.50/-1.00×151° diopters in the right eye and − 9.00/-2.00×43° diopters in the left. After the atropine mydriasis exam, the corrected refraction was − 5.25/-0.75×180° diopters in the right eye and − 5.50/-1.00×55° diopters in the left. Best corrected visual acuity (BCVA) was 20/125 in both eyes, and intraocular pressure was 16 mmHg. The axial length was 24.60 mm in the right eye and 24.76 mm in the left. Ocular fundus examination revealed a tesselated fundus and conus. B-mode ultrasonography showed posterior scleral chylomalacia and mild vitreous opacities in both eyes. The subfoveal choroidal thickness was 235 µm in the right eye and 214 µm in the left. The hemodynamics of the posterior ciliary artery was reduced bilaterally. Clinical diagnoses were bilateral congenital myopia and amblyopia. The combination of posterior scleral reinforcement, orthokeratology, and 0.01% atropine effectively delayed myopic progression in both eyes. Follow-up results in the 8th postoperative year revealed refractive correction of -5.00/-0.75×180° in the right eye and − 6.50/-0.50×60° in the left. The BCVA was 20/20 in both eyes. The binocular axial length was 25.77 mm in the right eye and 25.39 mm in the left. Subfoveal choroidal thickness was 256 µm in the right eye and 351 µm in the left. Hemodynamic parameters of the retrobulbar vessels in both eyes were within normal range. Amblyopia was successfully resolved within the first postoperative year. Visual function significantly improved, and stereoscopic vision was restored in the 3rd postoperative year after one year of visual function training. Postoperative orthokeratology combined with 0.01% atropine treatment was initiated in the 4th year after the PSR. This combined treatment approach effectively stabilized refraction, controlled the rate of axial length growth, and improved the subfoveal choroidal thickness and retrobulbar vascular perfusion. Currently, there have been no reported issues with visual acuity or ocular surface health, and the patients have expressed a high level of satisfaction.
Conclusion
PSR effectively controls the progression of myopic axial length and refractive error. Furthermore, the combination of orthokeratology and 0.01% atropine has shown to be even more effective in controlling myopia progression, particularly in patients with an early onset. In this report, 8 years of clinical observation indicated that this combined treatment regimen was effective and safe for myopia control.