Abstract: Myopia, particularly high myopia, has become a major global public health concern. During myopia progression, scleral remodeling is considered a key mechanism underlying axial elongation and is characterized by continuous alterations in scleral tissue structure, extracellular matrix metabolism, and biomechanical properties. Currently, surgical approaches targeting the sclera to control the progression of high myopia can be broadly classified into 2 categories. The first one is posterior scleral reinforcement (PSR), which reinforces the posterior pole of the globe using biological or synthetic materials. The second one is scleral collagen cross-linking (SXL), which enhances the stability of scleral collagen fibers. This review systematically summarizes the mechanisms, materials and surgical approaches, efficacy, and safety of PSR and SXL, with the aim of evaluating the clinical application prospects of sclera-targeted surgical interventions for the treatment of high myopia and informing clinical myopia management.