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November 1, 1985

Myopia and Scleral Reinforcement: A Sensitive Nerve-Reply

Author Affiliations

Myopia Clinic Manhattan Eye, Ear and Throat Hospital New York

JAMA. 1985;254(17):2414. doi:10.1001/jama.1985.03360170053029

In Reply.—  It appears that my negative comments on scleral reinforcement struck a sensitive nerve or two. Scleral reinforcement has proved to be an acute disappointment to me in its present form. My initial laboratory studies1 and clinical trials2 were both most encouraging. Long-term follow-up studies have indicated that these periscleral grafts do not effectively prevent axial elongation of the eye in my hands, however. I have stereophotographs of one youngster's fundus eight years postoperatively in which the cruciate-shaped reinforcement graft can be seen indenting the posterior pole. The posterior staphyloma, however, can be seen bulging outward in all areas around it. At our facility, A-mode ultrasonography also indicates that the great majority of eyes (85% ) elongate after scleral reinforcement surgery. This has also been observed in eyes in which the refractive myopia was stabilized or even showed regression.In my opinion, the reason that Drs Miller and