The aim of this study is to examine the effectiveness and safety of posterior scleral reinforcement (PSR) for treating anisometropic amblyopia and myopia associated with high myopia in children. Children with unilateral high myopia (uHM) and anisometropic amblyopia who underwent PSR in their highly myopic eyes were included in this study. The treated eye was designated as the PSR group, whereas the healthier eye served as the control, and paired comparisons were made. Thirteen patients (13 eyes in each group) were included, with an average age of 5.85±2.08 years. Cross-sectional comparisons between the groups showed that within 2 to 3 years after surgery, the PSR group had a significantly greater increase in best-corrected visual acuity per month compared with the control group (P=0.03), a significantly lower increase in axial length per month (P=0.007), and a significantly smaller absolute value of the increase in SE per month (P=0.002). Temporal longitudinal comparisons within the PSR group indicated that the increase in axial length per month 2 to 3 years after surgery was significantly slower than 1 year before surgery (P=0.045). The increase in best-corrected visual acuity per month was higher than 1 year before surgery, although not significantly (P=0.859). PSR is a safe and effective treatment for refractory anisometropic amblyopia caused by uHM, and for controlling axial length and the degree of myopia.