Scleral remodeling in myopic progression: Microenvironmental dynamics, molecular networks, and targeted therapeutic strategies.

Myopia is rapidly becoming a global health crisis, driven by excessive axial elongation that risks irreversible blindness. Abnormal scleral remodeling is the core process underlying myopic progression. This review systematically depicts the pathological remodeling of myopia as a multi-tissue collaborative and stepwise signaling process. We explored how myopic signals contribute to a pathological microenvironment driven by key synergistic factors, including hypoxia, inflammation, and metabolic reprogramming, which promote the phenotypic trans-differentiation of scleral fibroblasts and disrupt the homeostasis of the extracellular matrix, leading to weakened biomechanical strength. We discussed the effectiveness of drug interventions targeting specific receptors, the possibility of achieving biomechanical enhancement through scleral cross-linking, and the development of novel anti-hypoxia and anti-inflammatory drugs. In addition, we highlighted the latest breakthroughs in intelligent drug delivery systems, which are designed to enhance the bioavailability of the posterior pole. By combining the fundamental dynamics of the microenvironment with translational innovation, this review provides a theoretical basis for future precision medicine aimed at preventing myopic scleral remodeling.