The Effect of Atropine on Myopia

Sixty-two children were treated with atropine in one eye for one year; the fellow eye was the control. The eyes were switched the second year. Twenty-eight patients were treated for four years on the same basis. Control eyes showed significant increases in myopia compared to treated eyes. Some treated eyes showed decreases in myopia; no decreases were seen in control eyes. Posttreatment data analysis indicates the effects are long-term.     

低浓度阿托品在儿童近视控制中的研究进展

伴随着儿童近视发生率的上升和低龄化趋势,近视已成为亟需解决的全球公共卫生问题。控制近视发生发展的有效措施包括双焦眼镜、多焦眼镜、角膜塑形镜和药物等。近年来,阿托品作为控制近视发展的有效药物得到广泛关注。由于低浓度阿托品可以有效控制近视屈光度和眼轴增长,且畏光、视近模糊等不良反应轻,故低浓度阿托品已成为儿童近视防控的研究重点。现就低浓度阿托品在儿童近视控制中的研究进展进行综述。     

0.02%和0.01%阿托品滴眼液对近视儿童散光的影响

目的：观察0.02%和0.01%阿托品滴眼液对近视儿童的总散光和角膜散光的影响。方法：前瞻性队列研究。收集2016年6月至2017年6月就诊于郑州大学第一附属医院的400例近视儿童，其中0.02%阿托品+框架眼镜组138例，0.01%阿托品+框架眼镜组142例，单纯框架眼镜组120例。2个阿托品组均配戴全矫单焦框架眼镜，且每晚睡前双眼同时滴用0.02%或0.01%的阿托品滴眼液；单纯框架眼镜组仅配戴全矫单焦框架眼镜。每4 个月复查1 次，共随访1 年。采用IOLMaster测量角膜曲率；睫状肌麻痹验光获得等效球镜度数；标准矢量分析方法检测总散光和角膜散光（包括X、Y和轴向）。均选取右眼数据进行分析。采用方差分析、秩和检验和卡方检验进行数据分析。采用重复测量方差分析和广义估计方程GEE模型比较患者总散光、角膜散光以及角膜散光轴向的变化规律。结果：1年后，单纯框架眼镜组、0.01%阿托品+框架眼镜组、0.02%阿托品+框架眼镜组的总散光（包括X）均有所增加，差异有统计学意义（总散光：F时间=15.25，P=0.001；总散光X：wald χ2时间=48.07，P<0.001），但3 组间增加幅度基本一致，差异无统计学意义。3组的角膜散光（包括X）均逐渐增加，差异均有统计学意义（角膜散光：F时间=8.11，P=0.001；角膜散光X：wald χ2时间=20.79，P<0.001），但3组间增加幅度基本一致，差异无统计学意义。随着治疗时间的延长，3 组的总散光Y、角膜散光Y、总散光轴向和角膜散光轴向均稳定，且组间差异均无统计学意义。结论：近视儿童每晚规律应用0.02%或0.01%的阿托品滴眼液1年，对标准矢量分析法的总散光、角膜散光及二者的轴向均无影响。     

近十年阿托品延缓近视的文献计量可视化分析

目的：基于Web of Science数据库的收录情况,运用文献计量的方法分析阿托品在近视防控领域中应用的现状以及研究热点。方法：文献研究。以近十年（2011—2021年）Web of Science（WOS）中的核心数据库收录的关于阿托品在近视防控领域研究的文献为分析对象,利用CiteSpace软件,运用文献计量学方法,从文献的年发文量、国家及机构来源、刊文期刊分布及关键词突现、共被引文献分析等角度对其进行可视化分析。结果：共检索到290篇文献,发文量最多的国家是中国,其次是美国;发文量最多的研究机构是新加坡国立眼科中心,其次是新加坡国立大学和香港理工大学;发文最多的期刊为《Ophthalmic and Physiological Optics》以及《Investigative Ophthalmology and Visual Science》;研究的趋势从早期以动物实验为主来研究阿托品类药物的药理学及安全性到中期的临床随机对照试验及基于这些对照试验进行的一系列Meta分析,目前的研究热点为阿托品对脉络膜厚度的影响。结论：应用CiteSpace分析阿托品在近视防控领域运用的相关文献,展示出了该领域目前的主要研究及彼此合作的国家和机构,揭示了该领域的研究趋势。阿托品在近视防控中的应用潜力巨大,仍具有较高的研究价值。     

The Treatment of Myopia with Atropine and Bifocals: A Long-term Prospective Study

Two hundred fifty-three patients were followed for up to nine years (mean, 4 1/4 years). They were on a regimen of atropine 1 % once a day in an attempt to retard myopic progression. Their rate of myopic progression prior to atropine treatment was compared with 146 controls. The rates of myopic progression during and after treatment were also compared to those of the controls. The results from several analyses showed a marked flattening in the rate of myopic progression during treatment, and the rate of myopic progression after treatment ran parallel to those in the control group. Age in relation to myopic progression was evaluated in subgroups. A variation existed in the rate of myopic progression in the controls. The fastest rate of myopic progression occurred between eight and 12 years of age, and the slowest rate of myopic progression developed in those patients over 18 years of age.     

0.01%阿托品对青少年近视调节参数的影响

观察0.01%阿托品对青少年近视调节参数的影响。方法：前瞻性非随机对照研究。选取2015年 4月至2018年6月于聊城市第二人民医院眼科就诊的轻中度近视患者61例（122眼），年龄13～16 （14.4±0.9）岁，根据监护人意愿分为2组：阿托品组30例（60眼），滴用0.01%阿托品滴眼液1次；对照组31例（62眼），滴用玻璃酸钠滴眼液1次。阿托品组在用药前及用药后2、4、6 h行近视力、调节幅度和调节灵敏度检查。对照组在用药前及用药后2、6 h行近视力、调节幅度和调节灵敏度检查。采用重复测量方差分析、t检验对数据进行统计学分析。结果：点眼药前后，2组间近视力差异无统计学意义（F=0.209，P=0.650），各时间点近视力比较差异无统计学意义（F=0.292，P=0.594），组别与时间无交互作用（F=0.097，P=0.756）。阿托品组用药后2 h调节幅度低于对照组（t=-13.09， P<0.001），2 组间用药后6 h调节幅度差异无统计学意义（t=-0.26，P=0.797）；阿托品组用药后 2 h调节幅度[（10.09±0.69）D]较用药前[（12.58±0.88）D]下降（P<0.001），用药后4 h调节幅度（10.98±0.77）D较用药后2 h升高（P<0.001），用药后6 h调节幅度（12.45±0.77）D和用药前相比，差异无统计学意义（P=0.911）。阿托品组用药后2、6 h的调节灵敏度与对照组比较，差异均无统计学意义；阿托品组各时间点调节灵敏度比较差异无统计学意义（F=0.09，P=0.965）。结论：0.01%阿托品滴眼液滴眼部1次后，调节幅度下降，但剩余的调节力足够，不影响近视力和调节灵敏度。     

低浓度阿托品滴眼液在儿童青少年近视防控中的应用专家共识（2022）

当前全球近视患病率呈快速增长趋势，预计至2050年全球将有47.58亿近视人口，占总人口的49.8%[1]。中华人民共和国国家卫生健康委员会公布，2020年中国儿童青少年近视患病率为52.7%，其中小学生为35.6%，初中生为71.1%，高中生为80.5%[2]。由于近视呈现低龄化、高度化和患病率持续升高趋势，病理性近视患病率也显著增高。病理性近视可因脉络膜新生血管，视网膜变性、裂孔和脱离等眼底改变，造成不可逆的视觉损害，严重者可致盲，给个人、家庭和社会带来沉重负担。因此，预防近视发生、延缓近视进展、防止病理性近视发生刻不容缓。 阿托品药物在近视防控中的应用由来已久，近年来低浓度阿托品滴眼液的应用逐渐受到关注。尽管目前关于低浓度阿托品滴眼液的近视防控应用在中国未获得国家药监部门正式批准应用于临床，但在部分省份已经以院内制剂方式经省级药监部门批准在院内有条件的情况下使用，同时部分患儿亦可凭医师开具的处方通过互联网医院获得，但关于阿托品滴眼液的浓度选择，其有效性、安全性以及使用规范，国内尚无统一的指导性意见。从临床用药规范以及近视防控重要意义的双重角度考虑，有必要形成低浓度阿托品滴眼液的临床使用专家共识，以期为广大一线眼科工作者提供指导，推动我国近视防控工作的健康发展。 本专家共识由中华医学会眼科学分会眼视光学组、中国医师协会眼科分会眼视光专业委员会的组长和执笔团队在文献查阅、临床实践性研究的基础上酝酿而成，并由2个学组牵头组织近百名专家经过文献研究、初稿开放讨论、多轮修改和循证、审稿及定稿等程序，形成最终版本共识。 1? 阿托品的有效性 2? 机制 3? 安全性及不良反应处理 3.1 安全性和不良反应 3.1.1 瞳孔散大、畏光反应和眼压升高 3.1.2 调节能力和近视力下降 3.1.3 过敏反应 3.1.4 刺激性反应 3.2 不良反应的处理 4? 适应证和禁忌证 4.1 适应证 4.1.1 年龄 4.1.2 近视屈光度和增长量 4.1.3 依从性 4.2 禁忌证 5? 使用规范 5.1 基线评估 5.1.1 临床检查 5.1.2 近视快速进展危险因素评估 5.2 用药前宣教 5.3 用药过程和随访 5.4 停药 5.4.1 常规停药 5.4.1.1 停药时机选择 5.4.1.2 反弹效应 5.4.1.3 停药后重新再用药 5.4.2 异常停药 5.4.2.1 用药防控近视效果不佳 5.4.2.2 不良反应 6? 注意事项     

Atropine 0.01% eye drops slow myopia progression: a systematic review and Meta-analysis

AIM: To evaluate the effects of atropine 0.01% on slowing myopia progression. METHODS: We searched for relevant studies in the Cochrane Library, PubMed, Embase, Ovid, CBM, CNKI, VIP and Wan Fang Data in Chinese. A supplementary search was conducted in OpenGrey (System for Information on Grey Literature in Europe), the ISRCTN registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from the dates of inception to June 30, 2018. RESULTS: Seven randomized controlled trials (RCTs) with a total of 1079 subjects were included (505 in the atropine 0.01% group and 574 in the control group). The results showed that the atropine 0.01% group exhibited significantly greater control of axial growth than the control group [MD=-0.12, 95%CI (-0.19, -0.06)]. There was also a statistically significant difference between the atropine 0.01% and control groups in the changes in axial length [MD=-0.14, 95%CI (-0.25, -0.03)], but the quality of evidence was low. There were no significant differences between the atropine 0.01% and control groups in the overall effect with respect to diopter value, change in diopter, distance vision and intraocular pressure [MD=0.08, 95%CI (-0.27, 0.42); MD=0.09, 95%CI (-0.17, 0.36); MD= -0.01, 95%CI (-0.02, 0.00); MD=0.08, 95%CI (-0.56,0.40)]. The sensitivity analysis showed that the conclusion of the Meta-analysis is relatively stable. With respect to adverse events, there were significant differences between the atropine 0.01% and control groups [OR=0.26, 95%CI (0.11, 0.61)]. CONCLUSION: Based on the available evidence, atropine 0.01% eye drops offer benefits in controlling axial growth and safety without causing significant differences in diopter values, distance vision and intraocular pressure.     

Topical Atropine in Retarding Myopic Progression and Axial Length Growth in Children with Moderate to Severe Myopia: A Pilot Study

Purpose

To study the safety and efficacy of topical 1% atropine eye ointment in retarding myopic progression in children with moderate to severe myopia.

Methods

This was an interventional control study. Children (aged 5–10 years) with myopia of ?3.00 diopters (D) or more were treated with 1% atropine ointment once daily for 1 year. Baseline and regular assessments of refractive errors by cycloplegic autorefraction and of axial length were done by ultrasound biometry, and the results were compared with data of control subjects.

Results

Twenty-three children (mean age: 7.4 ± 1.6 years) with moderate to severe myopia, being treated in the Hong Kong Eye Hospital of the Chinese University of Hong Kong, were recruited into the atropine group, and 23 children from the same eye clinic were matched with the study subjects with respect to age, sex, and initial spherical equivalent refraction, as controls. The initial refractive errors were ?5.18 ± 2.05?D and ?5.12 ± 2.33?D in the atropine and the control groups, respectively (P = 0.934). Myopic progression was significantly less (P = 0.005) in the atropine group (+0.06 ± 0.79?D) than in the control group (?1.19 ± 2.48?D). Axial length increase was also significantly smaller in the atropine group (0.09 ± 0.19?mm) than in the control group (0.70 ± 0.63?mm) (P = 0.004). One child (4.3%) developed an allergic reaction. No other major adverse effects related to the treatment were noted.

Conclusion

Topical 1% atropine ointment is a safe and effective treatment for retarding myopic progression in moderate to severe myopia. Further large-scale randomised controlled study with longer follow-up seems warranted.?Jpn J Ophthalmol 2007;51:27–33 © Japanese Ophthalmological Society 2007