Strengthening the sclera with a strip of fascia lata in progressive myopia.

The surgical methods of treating myopia may be divided into two groups: (I) Removal of the clear lens (Fukala, I890), operations on the cornea to reduce its refractive power (Sato, Akiyama, and Shibata, I953), lamellar resection of the sclera, implantation of an intraocular lens (Choyce, I964). These operations decrease the degree of myopia but do not check its progress. (2) Operations which disrupt the pathogenetic mechanism responsible for the progress of the myopia by supporting the posterior segment of the sclera with auto-or homo-transplants. are used for this purpose and good results have been reported. There is no further stretching of the globe and visual acuity improves. The reduction of myopia usually reported is probably due to the postoperative contraction of the transplant and sclera. In our opinion the procedure of strengthening the sclera with fascia lata offers the best prognosis. Fascia tissue is not only more elastic than either sclera or tendon, easy to handle, and sufficiently strong (Curtin, I960), but can also be taken from the patient himself. The method of supporting the posterior sclera with a strip of fascia lata was worked out experimentally by Shevelev (I930). Later Curtin (I960, I96I) described a similar operation which he had performed successfully on seven subjects with progressive myopia. Eroshevsky (i968) has reported favourably on the results of Curtin's operation which he has performed on twenty eyes. We have simplified and improved the Shevelev-Curtin operation. A description of the technique and a report on the results in 84 eyes of 67 patients form the subject of the present communication. Surgical technique INSTRUMENTS Along with the conventional instruments we use a special fascial stripper to dissect the strip of fascia and a hooked carrier to pass the fascia behind the globe (Fig. i, opposite). The stripper consists of two tubes, one inside the other. The outer tube (I 70 mm. long, outer diameter 8 mm., inner diameter 6 mm.) has a handle at one end, and the other end is tapered to a cone. The inner tube is the same length as the outer one, and its diameter is such that it moves freely inside it.