Possibilities of a differentiated approach to the treatment of congenital and acquired myopia

Aim: The aim of this investigation is to study the pathogenetic, clinical, and functional differences between congenital and acquired myopia for creating differentiated strategies of treatment and preventing complications in various forms of myopia.

Materials and methods: This study included 377 patients, aged 2.5 to 43 years. It involved performing 120 operations (120 eyes) on 90 patients according to our methods, using a sealant by the Snyder-Thompson method. The observation period was from 3 to 8 years. The ophthalmic examination included visometry, autorefractometry for conditions of cycloplegia, biomicroscopy, ophthalmoscopy, echobiometry, and an examination on the analyzer of biomechanical properties of the eye. The level of cortisol in the serum and the vegetative Kerdo index (KI) were determined according to a known technique.

Results: We have established that the characteristic features of congenital myopia are relatively higher when compared with acquired high myopia, the values of corneal hysteresis (CG), and acoustic sclera density (APS), a less pronounced hormonal imbalance, and a narrower range of vibrations of the KI. Scleral reinforcement surgery sealed the posterior pole and had a 100% stabilizing effect for one year, 95.2% for three years, and 90.5% for six to eight years. A decrease in the frequency of high degree amblyopia was revealed in patients with soft contact lenses (62.8%), with a bioptic correction type of 70%, and in patients with toric MKL (TQCL) by 72%.

Conclusions: The proposed additional diagnostic criteria for congenital and acquired myopia allow the verification of the diagnosis. They should be considered in predicting the course and choosing appropriate treatment strategies for various forms of myopia. The developed technique of scleral reinforcement treatment of complicated high myopia by sealing the posterior pole of the eye with an implant from a biologically active synthetic plastic material that does not undergo biodegradation. This makes it possible to improve the metabolism of the tissues of the posterior pole, stabilize the myopic process effectively, increase visual functions, and inhibit the development of ocular complications. An optimal correctional tactic was developed for increasing visual acuity in patients with congenital nearsightedness above 10.0 Dpt., and myopic astigmatism of medium and high degrees, which consisted of the combination of MKL with spectacular correction of the astigmatic component (bioptics).