**Conflict of interest**

*Intraocular Lens*

of myopia.

in human eyes.

group [59, 60].

**3. Conclusion**

**2.3 Surgical management**

*2.2.3 Anti-hypoxic drugs*

and pulmonary hypertension [56, 57].

countries, and more recently it has been adopted by the Western countries as well. With further investigation and modification to the treatment regimen that evades rebound phenomenon, atropine has the potential to be the conventional treatment

Anti-hypoxic drugs such as salidroside and formononetin have shown antihypoxic effects to treat scleral hypoxia in myopia [53, 54]. Scleral hypoxia, which is induced by Hypoxia-Inducible Factor-1α (HIF-1), triggers a signaling cascade for myofibroblast trans-differentiation leading to scleral extracellular collagenous matrix remodeling in progressing myopia [55]. Formononetin is known decrease HIF-1α, vascular endothelial growth factor (VEGF) and prolyl hydroxylase domain-2 (PHD-2), which are protective in hypoxia-induced retinal neovascularization [54]. Salidroside is protective against for hypoxia-induced cardiac apoptosis

In animal models with experimentally induced myopia, anti-hypoxic drugs down-regulated HIF-1α expression and the phosphorylation levels of eIF2α and mTOR to inhibit the development of form deprivation myopia, without affecting the normal ocular growth in guinea pigs [55]. Due to encouraging results in animal models, the use of anti-hypoxic drugs shows great potential for treatment of myopia

Surgeons have recently advocated for surgical intervention to halt the progression of myopia, axial elongation and weakening of the posterior sclera. Macular buckle surgery or posterior reinforcement (PSR) surgery is proven to be effective in reinforcing the weakened posterior sclera. A scleral buckle is used to apply direct mechanical force onto the posterior pole, which slows the axial elongation. Shen et al. documented significantly higher Best-Corrected Visual Acuity (BCVA) and lower refractive error in the group who underwent macular buckle surgery compared to the control group [58]. Additionally, patients who underwent PSR surgery have a shorter mean axial length and lower mean refractive error than the control

Macular buckling surgery has also been used myopic macular hole with retinal detachment and posterior staphyloma, which displayed high reattachment rates and improved visual acuity [61, 62]. Recent studies have experimented with different buckle materials, shapes, techniques and other modifications for the best correction of myopia and its complications [63–65]. With more advanced techniques and modifications, the surgical technique can be utilized as conventional treatment of

The global prevalence of myopia is in an increasing trend, with estimates of myopia and high myopia affecting nearly 5 billion and 1 billion people, respectively, in 2050 [1]. As a major public health concern, it is essential to develop interventions that sufficiently delay or stop the progression of myopia. Of the above discussed treatments, all have shown to reduce the progression of myopia, but atropine has been the most popular and effective in reducing progression and axial elongation. Despite the expected side effects, its rebound phenomenon and its obscure

myopia to reduce myopia progression and axial elongation.

**94**

There are no financial conflicts of interest.
