Management of Anisometropic Amblyopia Associated with Unilateral High Myopia in Children with Modified Posterior Scleral Reinforcement.

Introduction: The aim of the study was to evaluate the effect of modified posterior scleral reinforcement (PSR) surgery integrated with comprehensive amblyopia rehabilitation in children with high myopia-related anisometropic amblyopia.

Methods: A retrospective cohort analysis was conducted, including 24 eyes treated with the modified PSR intervention and 20 nonsurgical controls. Baseline and 3-year postoperative assessments included best-corrected visual acuity (BCVA), cycloplegic spherical equivalent (SE), and axial length (AL).

Results: At the 3-year follow-up, the PSR cohort exhibited significant BCVA enhancement (p < 0.001) alongside suppressed myopic progression, as evidenced by reduced SE deterioration (p < 0.001) and AL elongation (p < 0.001), compared to controls. Amblyopia treatment success rates were markedly higher in the surgical group (p < 0.001). Stratified analyses revealed greater BCVA gains in the PSR group across all amblyopia severities, with pronounced improvements in severe amblyopia cases. Age-specific outcomes demonstrated attenuated AL growth in both preschoolers (<6 years, p < 0.01) and school-aged children (≥6 years, p < 0.05). Notably, younger preschoolers in the PSR group achieved superior BCVA gains (p < 0.05), whereas older controls showed limited responsiveness.

Conclusion: The combination of modified PSR surgery and multidisciplinary amblyopia rehabilitation represents a promising therapeutic approach for mitigating refractive error progression and enhancing visual outcomes in children with high myopia-associated anisometropic amblyopia.