Modified Posterior Scleral Reinforcement with Comprehensive Therapy in High and Pathologic Myopia: A Prospective Cohort Study

This prospective cohort study aimed to assess the efficacy and safety of modified posterior scleral reinforcement (PSR) combined with comprehensive therapy versus conventional optical correction for controlling myopia progression in patients with high and pathologic myopia. A total of 203 patients aged 8-18 years were allocated, based on preference, to either the combination therapy group (n = 111; receiving modified PSR plus low-concentration atropine and/or peripheral defocus optical correction) or the conventional control group (n = 92; fitted with rigid gas-permeable contact lenses only). After accounting for 10 withdrawals during the study period, 193 patients completed the 24-month follow-up (combination group, n = 102; control group, n = 91) and were included in the final analysis. The primary outcomes were changes in axial length (AL) and spherical equivalent (SE). Secondary outcomes included best-corrected visual acuity (BCVA), posterior segment structural lesions, and adverse events. After 24 months, the combination therapy group showed significantly less AL elongation (0.33 ± 0.13 mm vs 0.70 ± 0.23 mm, p < 0.001) and SE progression (-0.75 ± 0.27 dioptres [D] vs -1.48 ± 0.57 D, p < 0.001) than the control group. The combination therapy group also demonstrated greater improvement in BCVA (p < 0.001) and lower rates of progression of myopic tractional maculopathy (2.9% vs 12.1%, p = 0.014) and aggravated tessellated fundus (6.9% vs 17.6%, p = 0.022) than the control group. The incidence of adverse events did not differ significantly between the groups (4.9% vs 4.4%, p = 1.000). In real-world clinical practice, personalized combination therapy centered on modified PSR is associated with slower axial elongation and refractive error progression and may help to stabilize posterior segment structures in patients with high and pathologic myopia, demonstrating more favorable clinical outcomes than conventional optical correction alone.