Atropine for the Treatment of Childhood Myopia: Changes after Stopping Atropine 0.01%, 0.1% and 0.5%
Atropine for the Treatment of Childhood Myopia: Changes after Stopping Atropine 0.01%, 0.1% and 0.5%
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DOI：
10.1016/j.ajo.2013.09.020
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发表时间：
2014-02-01
影响因子：
4.2
通讯作者：
Tan, Donald
中科院分区：
文献类型：
--
作者：
Chia, Audrey;Chua, Wei-Han;Tan, Donald
目的：研究停用阿托品1年后近视眼等效球镜参数及其他参数的变化。设计：前瞻性随机双盲临床试验。方法：对400名6~12岁近视儿童分别给予0.5%、0.1%、0.01%阿托品治疗24个月，停药后复查。父母和孩子知情同意参与这项研究。分别在26个月、32个月和36个月时对儿童进行复查，并评估眼轴长度(AL)、视力、瞳孔大小和调节能力的变化。结果：356名儿童(89%)进入消退期。在进入试验时，不同阿托品组的儿童在年龄、性别、SE或AL方面没有显著差异。在接下来的12个月里，0.5%的患者近视进展更快(-0.87+/-0.52D)，而0.1%的患者(-0.68+/-0.45D)和0.01%的患者(-0.28+/-0.33D，P<；0.001)近视进展更快。与0.01%眼(0.19±0.13 mm，P<；0.001)相比，0.5%(0.35±0.20 mm)和0.1%(0.33+/-0.18 mm)眼的眼压增长也更大。所有组的瞳孔大小和近视力均恢复到阿托品前水平，但在36个月时，0.5%的眼(13.24+/-2.72D)的调节能力低于0.1%(14.45+/-2.61D)和0.01%的眼(14.04+/-2.90D，P<；0.001)。在整个36个月中，0.5%组、0.1%组和0.01%组的SE分别增加了-1.15+/-0.81D、-1.04+/-0.83D和-0.72+/-0.72D(P<；0.001)。结论：停用阿托品后存在近视反弹，且使用0.5%和0.1%阿托品的近视反弹更明显。然而，0.01%阿托品的作用更受调制和持续。
PURPOSE: To study the change in spherical equivalent and other ocular parameters 1 year after stopping the administration of atropine.DESIGN: Prospective randomized double-masked clinical trial.METHODS: We assigned 400 myopic children, 6 to 12 years of age, to receive atropine 0.5%, 0.1% or 0.01% for 24 months, after which medication was stopped. Parents and children gave informed consent to participate in the research. Children were reviewed at 26, 32 and 36 months, and changes in cycloplegic spherical equivalent (SE), axial length (AL), visual acuity, pupil size, and accommodation were assessed.RESULTS: Of the children, 356 (89%) entered into the washout phase. At entry, there was no significant difference in age, gender, SE, or AL among the children in the various atropine groups. Over the following 12 months, myopic progression was greater in the 0.5% eyes (-0.87 +/- 0.52 D), compared to the 0.1% (-0.68 +/- 0.45 D) and 0.01% eyes (-0.28 +/- 0.33 D, P < 0.001). AL growth was also greater in the 0.5% (0.35 0.20 mm) and 0.1% (0.33 +/- 0.18 mm) eyes, compared to the 0.01% eyes (0.19 +/- 0.13 mm, P < 0.001). Pupil size and near visual acuity returned to preatropine levels in all groups, but accommodation at 36 months was less in the 0.5% eyes (13.24 +/- 2.72 D) compared to the 0.1% (14.45 +/- 2.61 D) and 0.01% eyes (14.04 +/- 2.90 D, P < 0.001). The overall increase in SE over the entire 36 months in the 0.5%, 0.1% and 0.01% groups was -1.15 +/- 0.81 D, -1.04 +/- 0.83 D and -0.72 +/- 0.72 D, respectively (P < 0.001).CONCLUSION: There was a myopic rebound after atropine was stopped, and it was greater in eyes that had received 0.5% and 0.1% atropine. The 0.01% atropine effect, however, was more modulated and sustained.