Multifocal electroretinogram in children on atropine treatment for myopia

AIM: To assess retinal function by multifocal electroretinogram (mfERG) in children on atropine eye drops for the treatment of myopia. METHODS: mfERGs were recorded in children receiving atropine eye drops (n = 48) once daily for 2 years and in those receiving placebo eye drops (n = 57) for a similar time. All recordings were performed between the second and third month of cessation of atropine/placebo treatment by a masked investigator. The amplitude and implicit time of the first order kernel (k1) and first slice of the second order kernel (k21) of mfERG responses were used to study the outer and inner retinal function, respectively. RESULTS: There was no significant reduction in k1 response amplitudes of the atropine group compared to that of the placebo group (N1, p = 0.181; P1, p = 0.150). No significant difference in the k1 response implicit times between the groups was found (N1, p = 0.767; P1, p = 0.849). The differences in the k21 amplitudes and implicit times between the groups were not statistically significant (k21 amplitude, p = 0.058; k21 implicit time, p = 0.156). CONCLUSIONS: Daily atropine usage over 2 years for the treatment of myopia has no significant effect on retinal function as demonstrated by recordings of mfERG.     

低浓度阿托品治疗近视的临床研究进展

阿托品是毒蕈碱受体抑制剂,1％浓度滴眼可以抑制近视的发展及眼轴的增长,但是畏光、视近模糊等常见的副作用限制了其临床应用.近期研究者逐渐将兴趣转向低浓度阿托品（小于1％浓度）的临床研究,发现低浓度阿托品滴眼可以有效延缓近视发展,比1％浓度的阿托品副作用更小,疗效也更持久稳定.     

0．05％阿托品控制儿童近视眼进展的研究

目的探讨0．05％阿托品控制儿童近视眼进展的效果。设计前瞻性病例系列。研究对象64例6～13岁患近视眼的学龄儿童。方法将64例临床诊断的近视眼学龄儿童按照随机数字表法随机分为两组：试验组30例,每晚睡前点用0．05％阿托品滴眼液;对照组34例,不做任何治疗。观察1年,每月1次,检查视力、屈光状态和眼轴,比较两组的差异。主要指标屈光度、眼轴。结果阿托品治疗组患者近视眼进展（-0．28±0．26）D／年,显著低于对照组（-0．75±0．35）D／年（P=0．008）。阿托品治疗组眼轴增长（0．30±0．28）mm也低于对照组（0．65±0．61）mm（P=0．004）。阿托品治疗组患者无畏光、视物不清,眼压、裂隙灯及眼底检查无异常。结论在至少1年规律应用的情况下,0．05％阿托品是控制多数学龄儿童近视眼进展的有效药物。     

阿托品控制近视增长的研究进展

近年来青少年近视发生率逐年上升,并且呈低龄化趋势。目前,用于治疗和控制近视增长的方法很多,如框架眼镜、角膜塑形镜、药物等,治疗和控制效果各异。其中,阿托品在控制近视增长方面效果显著,高浓度（1%、0.5%、0.1%）阿托品可以有效抑制近视屈光度和眼轴的增长,但同时伴有一些由药物本身药理作用引起的不良反应,如畏光、视近模糊等,而低浓度（0.01%）阿托品在保留近视控制作用的同时,不良反应相对较轻,患者接受度较高。现就阿托品在控制近视增长方面的一些研究进展做一综述。     

A 3-year follow-up study of atropine treatment for progressive myopia in Europeans

BackgroundAtropine is the most powerful treatment for progressive myopia in childhood. This study explores the 3-year effectiveness of atropine in a clinical setting.MethodsIn this prospective clinical effectiveness study, children with progressive myopia ≥ 1D/year or myopia ≤ −2.5D were prescribed atropine 0.5%. Examination, including cycloplegic refraction and axial length (AL), was performed at baseline, and follow-up. Outcome measures were spherical equivalent (SER) and AL; annual progression of SER on treatment was compared with that prior to treatment. Adjustments to the dose were made after 1 year in case of low (AL ≥ 0.3 mm/year) or high response (AL < 0.1 mm/year) of AL.ResultsA total of 124 patients were enrolled in the study (median age: 9.5, range: 5–16 years). At baseline, median SER was −5.03D (interquartile range (IQR): 3.08); median AL was 25.14 mm (IQR: 1.30). N = 89 (71.8%) children were persistent to therapy throughout the 3-year follow-up. Median annual progression of SER for these children was −0.25D (IQR: 0.44); of AL 0.11 mm (IQR: 0.18). Of these, N = 32 (36.0%) had insufficient response and were assigned to atropine 1%; N = 26 (29.2%) showed good response and underwent tapering in dose. Rebound of AL progression was not observed. Of the children who ceased therapy, N = 9 were lost to follow-up; N = 9 developed an allergic reaction; and N = 17 (19.1%) stopped due to adverse events.ConclusionIn children with or at risk of developing high myopia, a starting dose of atropine 0.5% was associated with decreased progression in European children during a 3-year treatment regimen. Our study supports high-dose atropine as a treatment option for children at risk of developing high myopia in adulthood.Subject terms: Outcomes research, Drug therapy     

The diluted atropine for inhibition of myopia progression in Korean children

AIM: To evaluate the efficacy and safety of three different concentrations of diluted atropine for the control of myopia in Korean children, and to assess the risk factors associated with rapid myopia progression. METHODS: A total of 285 children, with refractive errors within the range of -6 diopters (D) between 5 and 14 years of age were included. After using 0.01%, or 0.025%, or 0.05% atropine, for about 1y, changes in refraction, axial lengths and frequency of adverse events were analyzed. Logistic regression analyses were performed to evaluate the risk factors associated with rapid myopia progression. RESULTS: The changes in the mean spherical equivalent values were -0.134 D/mo in the before atropine group, -0.070 D/mo in the 0.01% atropine group, -0.047 D/mo in the 0.025% atropine group, and -0.019 D/mo in the 0.05% atropine group, with significant differences between the groups (P<0.001). The axial elongation was 0.046 mm/mo, 0.037 mm/mo, 0.025 mm/mo, and 0.019 mm/mo respectively, with significant differences between the groups (P=0.003). The incidence of photophobia and near vision difficulty was not different among the three atropine groups (P=0.425 and P=0.356, respectively). Multivariate logistic regression analyses showed that only highly myopic parents were a significant predictive factor of rapid myopia progression in Korean children (odds ratio, 8.155; 95% confidence interval, 3.626-18.342; P<0.001). CONCLUSION: Treatment with 0.01%, 0.025% and 0.05% atropine solution inhibits myopia progression in Korean children in a dose-dependent manner. Children with highly myopic parents preferentially shows a rapid myopia progression rate.     

阈值和阈值前期早产儿视网膜病变儿童视网膜电图观察

目的用全视野闪光视网膜电图（F-ERG）评价既往患阈值或阈值前期早产儿视网膜病变（ROP）JL童的视网膜功能。方法用F-ERG检查34例（68眼）既往有早产儿童,患阈值或阈值前期ROP者24例（48眼）,出生年龄体重匹配的未患ROP者10例（20眼）。统计分析两组儿童暗视和明视各反应a波、b波潜伏期和振幅的差异。结果ROP组较对照组暗视视杆反应和最大混合反应a波、b波潜伏期延长,振幅降低,差异有统计学意义,P〈O．05。ROP组与对照组明视视锥反应a波、b波振幅和潜伏期无明显差别,P〉0．05。结论阈值或阈值前期ROP视网膜功能受到影响,以视杆细胞的功能降低为主。F-ERG是评价早产儿视网膜功能有效检测手段。     

阈值期和阈值前期早产儿视网膜病变的远期视网膜电图特征

目的 观察阈值期和阈值前期早产儿视网膜病变（ROP）的远期视网膜电图特征。方法 诊断为阈值期或阈值前期ROP的24例患儿48只眼（ROP组）纳入研究。选择出生年龄、体重与之匹配的未发生ROP的早产儿10例20只眼为对照组。经过湖南省儿童医院医学伦理委员会批准并取得所有受检者父母的知情同意后,所有受检儿行全视野闪光视网膜电图（F-ERG）检查,记录视杆反应、最大混合反应以及视锥反应。结果 与对照组比较,ROP组患儿的视杆反应b波潜伏期明显延长,差异有统计学意义（t=5.643,P＜0.05）;振幅明显降低,差异也有统计学意义（t=7.068,P＜0.05）。与对照组比较,ROP组患儿的最大混合反应a、b波潜伏期均延长,差异有统计学意义（t=3.099、2.886,P＜0.05）;振幅均降低,差异也有统计学意义（t=5.614、2.850,P＜0.05）。与对照组比较,ROP组患儿的视锥细胞反应a、b波潜伏期（t=0.819、0.948）及振幅（t=0.904、0.850）无明显变化,差异均无统计学意义（P＞0.05）。结论 阈值期和阈值前期ROP患儿远期视网膜视杆反应b波及最大混合反应a、b波潜伏期延长,振幅降低;视锥反应a、b波无明显变化。     

Further observations on use of atropine in the treatment of myopia

In order to further our observations on the effects of atropine eyedrops for the management of myopia, we conducted a retrospective study of seventy-nine (79) patients, followed over a ten-year period (1971 to 1980). The atropine sulfate drops were used daily in most cases, tapering the frequency in the later teenage years. In general, those children who showed a good initial response during their first year of treatment, continued to use them for several years. Bifocal or reading glasses were used and family acceptance was good. Those children who showed less favorable results in the first year or who had unconcerned parents, stopped the drops within a year or two and went back to glasses or later, contact lenses. The data support the fact that children with low refractive errors may well have "functional myopia," as opposed to the "axial myopia," that characterizes the higher levels of myopia. These low degree myopes are the best candidates for using atropine to reduce or diminish myopia changes.     

Effects of different concentrations of atropine on controlling myopia in myopic children.

Although 1% atropine effectively slows myopia progression, it is associated with adverse effects, including photophobia, blurred near vision, and poor compliance. We investigated whether lower doses of atropine would control myopia progression. One hundred and eighty-six children, from 6 to 13 years of age, were treated each night with different concentrations of atropine eye drops or a control treatment for up to 2 years. The mean myopic progression in each of the groups was 0.04 +/-0.63 diopter per year (D/Y) in the 0.5% atropine group, 0.45+/-0.55 D/Y in the 0.25% atropine group, and 0.47+/-0.91 D/Y in the 0.1% atropine group. All atropine groups showed significantly less myopic progression than the control group (1.06+/-0.61 D/Y) (p<0.01). Our study also showed that 61% of students in the 0.5% atropine group, 49% in the 0.25% atropine group and 42% in the 0.1% atropine group had no myopic progression. However, 4% of children in the 0.5% atropine group, 17% in the 0.25% atropine group, and 33% in the 0.1% atropine group still had fast myopic progression (>-1.0 D/Y). In contrast, only 8% of the control group showed no myopic progression and 44% had fast myopic progression. These results suggest that all three concentrations of atropine had significant effects on controlling myopia; however, treatment with 0.5% atropine was the most effective.     

To the treatment of progressive myopia in children

The paper deals with a new treatment technology for childhood progressive myopia concurrent with chronic diseases. The technology of vision preservation in children of a general educational establishment includes complex phytotherapeutic exposure and infrasound pneumomassage of eyeball tissues. Infrasound ocular pneumomassage at a pressure of 0.1 atm, with a frequency of 4 Hz, and an infrasound power of 170 dB improves muscle accommodation function, blood circulation and lowers intraocular pressure. The developed complex technology contributes to a reduction in the incidence of exacerbations of chronic diseases and exerts a beneficial effect on the course of myopia in children.     

1%阿托品眼膏控制近视性散光青少年近视进展的一年疗效

目的 研究1%阿托品眼膏控制近视性散光青少年近视进展的一年疗效。设计 病例对照研究。研究对象 选择2013年2-9月在宁波市眼科医院视光门诊诊治的120例（240眼）6~9岁近视性散光患者（近视性散光≥-1.50 D,等效球镜在-1.00~ -4.00 D,弱视已治愈）。方法 采用随机数字表法将患者分为A、B、C三组,每组均为40例80眼,A组戴框架眼镜,B组戴框架眼镜联合0.5%复方托吡卡胺滴眼液1次/晚,C组戴框架眼镜联合1%阿托品眼膏1次/周五晚。随访12个月,每个月复查最佳矫正视力、屈光状态、眼压及眼轴变化。主要指标 视力、屈光度及眼轴。结果 随访12个月时,A组、B组和C组患者近视屈光度进展分别为（-1.22±0.38）D、（-1.07±0.31）D和（-0.38±0.25）D,各组之间比较差异有统计学意义（F=58.031, P<0.001）;眼轴增长分别为（0.48±0.21）mm、（0.39±0.15）mm和（0.15±0.09）mm,各组之间比较差异有统计学意义（F=24.612, P<0.001）;散光屈光度变化分别为（+0.33±0.12）D、（+0.21±0.18）D和（+0.26±0.13）D,各组之间比较差异无统计学意义（F=0.253, P=0.901）;各组患者均无明显不适主诉及高眼压等眼部并发症。结论 随访一年的结果表明,戴框架眼镜联合1%阿托品眼膏每周五晚1次能安全、有效地控制近视性散光青少年近视的进展,适宜基层医院推广。（眼科, 2016, 25： 298-301）     

Short-term effect of 0.01% atropine sulphate eye gel on myopia progression in children

AIM: To investigate the effect of 0.01% atropine sulphate eye gel on myopia progression and axial elongation in a 6-month treatment in children. METHODS: Totally 185 children aged 6-12y with binocular myopia of 3.0 D or less in both eyes were enrolled in this prospective cohort study. The atropine group (n=125) received one drop of 0.01% atropine sulphate eye gel in each eye before bedtime daily. The control group included 60 matched children without drug intervention during the same period. The spherical equivalent and axial length was recorded at baseline and the sixth month of treatment. The efficacy was evaluated by the change of the spherical equivalent and axial length. Adverse events were also recorded. RESULTS: The average spherical equivalent and axial length at baseline were not statistically significant between the atropine group (-1.64±0.80 D, 24.13±0.76 mm) and the control group (-1.59±0.94 D, 24.06±0.77 mm, P>0.05). After 6mo, there was significantly difference in the spherical equivalent progression between the atropine and the control group (-0.27±0.33 vs -0.60±0.35 D, P<0.001), with a relative reduction of 55.0% in myopia progression. The increase in axial elongation in the atropine group was significantly less than control group (0.19±0.14 vs 0.26±0.14 mm, P<0.001), with a relative reduction of 26.9% in axial length. The 84.4% and 38.4% of the eyes progressed by less than 0.50 D and remained stable in the atropine group, compared with 51.7% and 4.2% in the control group. No adverse events were observed. CONCLUSION: Atropine sulphate eye gel 0.01% can slow down myopia progression and axial elongation in children with a 6-month treatment.