阿托品眼膏及环戊通眼液散瞳儿童验光结果对比分析

目的 比较屈光不正儿童使用1%环戊通眼液与1%阿托品眼膏后检影验光结果的差异情况.方法 对226例(452只眼)屈光不正儿童使用环戊通眼液扩瞳后检影验光,48h后用1%阿托品眼膏对相同的患者再行扩瞳检影验光,比较两次验光结果.结果 远视组中两种药扩瞳验光结果球镜差值≤0.5D的眼数占72.2%,球镜差值＞0.5D的眼数为27.8%;阿托品眼膏扩瞳后验光的远视球镜值均高于环戊通眼液扩瞳后验光的结果.随着年龄增加,两种药验光的远视球镜差异值下降,2～5岁组与5～7岁组和7～12岁组比较,球镜差异值均有统计学意义.2～8岁组中近视球镜差值＞0.5D的眼数占9%,8～12岁组中近视球镜差值＞0.5D的占2.7%.混合性散光组中两种药扩瞳验光结果球镜差值＞0.5D的眼数占32%.使用两种药扩瞳后验光,近视和混合性散光组的前、后柱镜差值无统计学意义,而远视组的前、后柱镜差异有统计学意义,但差异＞0.5D的仅为1.8%.结论 1%环戊通眼液扩瞳验光结果与阿托品眼膏扩瞳验光结果比较,主要表现为球镜值的误差,柱镜值误差极小.8岁以上近视儿童首诊验光可使用环戊通作为睫状肌麻痹剂.12岁以下的远视和混合性散光儿童验光应尽量使用1%阿托品眼膏扩瞳.     

托吡卡胺与阿托品扩瞳验光结果对比研究

目的:了解5g/L托吡卡胺滴眼液与10g/L阿托品眼膏扩瞳对不同年龄阶段儿童验光结果的影响。方法:对212例疑屈光不正儿童先用5g/L托吡卡胺滴眼液扩瞳验光;待瞳孔恢复,再用10g/L阿托品眼膏扩瞳验光,比较两种扩瞳方法的结果。结果:远视组:球镜:相同5.6%,差异≥0.25DS者94.4%,柱镜:相同32.2%,差异≥0.25DC者67.8%,球、柱镜均以10g/L阿托品眼膏扩瞳高于5g/L托吡卡胺滴眼液扩瞳验光结果;各年龄组之间两两比较,具有显著统计学意义(P=0.000,P<0.01);近视组:球镜:相同者为10.7%,有不同程度的差异占89.3%;柱镜:相同者为26.7%,有不同程度的差异占73.3%,球、柱镜均以5g/L托吡卡胺滴眼液扩瞳高于10g/L阿托品眼膏扩瞳验光结果;混合散光组:球镜:33眼中有不同程度的差异占100.0%,以差异最大值为1.25DS,柱镜:33眼中两种扩瞳方法结果相同者40.0%,差异0.25～0.5DC者60.0%。结论:为确保验光结果的准确性,远视和混合散光12岁以内的儿童必须用10g/L阿托品眼膏扩瞳验光。     

盐酸环喷托酯滴眼液与阿托品眼膏在儿童验光中的比较

目的：探讨应用1%盐酸环喷托酯滴眼液对3~12岁视力低下儿童进行散瞳验光的可行性。方法对80例（160眼）视力低下儿童先后用1%盐酸环喷托酯滴眼液与1%阿托品眼膏进行散瞳验光,将两种散瞳剂的验光结果进行对比。按屈光状态分为远视组、近视组和散光组;其中散光值是将柱镜独立分出统计。结果散光组两种散瞳剂的验光结果间差异无统计学意义,远视组、近视组的两种验光结果间有显著性差异并存在相关性。结论1%盐酸环喷托酯滴眼液仍无法替代1%阿托品成为儿童常规散瞳验光用药。但对于单纯的散光的儿童,可用1%盐酸环喷托酯滴眼液替代1%阿托品眼膏进行散瞳验光。     

美多丽与阿托品对青少年远视散瞳验光结果的影响

目的:比较美多丽眼液与阿托品眼膏对青少年远视散瞳验光结果的影响。方法:用美多丽眼液与阿托品眼膏对116眼(8~16岁)青少年远视患儿进行散瞳视网膜检影验光。结果:远视球镜度数116眼两次验光结果相同或相差≤0.50D者94眼,相差0.75D以上22眼,远视球镜度数符合率为81.0%,52眼复性远视柱镜度数符合率为92.2%,散光轴向符合率为84.6%,28眼远视年龄在8~12岁者,两次验光结果验光度数相同和相差≤0.50D,散光轴向≤5°者7眼,符合率25.0%,88眼年龄在12~16岁,符合率97.7%,≥0.75D者两例均合并有内斜视,本组两种不同散瞳剂散瞳验光结果对比远视球镜或复性远视柱镜度数相差0.75D以上者均为美多丽散瞳年龄≤12岁者或有斜视者,低于阿托品散瞳验光度数。结论:年龄≤12岁的远视和初步诊断远视合并斜视患者,需用阿托品眼膏散瞳视网膜检影验光,对于年龄大于12岁的青少年远视无斜视者可以用美多丽眼液代替阿托品眼膏散瞳视网膜检影验光。     

环戊通与阿托品睫状肌麻痹效果的差异性评价

背景 为获得准确的屈光不正度数,需要对初诊的屈光不正儿童进行充分的睫状肌麻痹验光,但是如何选择睫状肌麻痹剂存在争议. 目的 观察环戊通和阿托品对屈光不正低龄儿童睫状肌麻痹效果是否存在差异,为研究临床上环戊通是否可以替代阿托品进行部分低龄儿童的睫状肌麻痹验光提供参考依据.方法 前瞻性临床研究.采用自身配对设计的方法,在检查对象监护人的知情同意和配合下,对80例160眼、年龄4～9周岁的屈光不正儿童进行睫状肌麻痹验光,先使用质量分数1％硫酸环戊通滴眼液点眼,每5分钟1次,共3次,末次点眼45 min后行验光检查;3d后再使用质量分数1％硫酸阿托品眼用凝胶点眼,每天点眼3次,连续3d,于第4天复查验光;比较两种药物散瞳后电脑验光、检影验光及残余调节的屈光度值差异.结果 散瞳前和应用1％硫酸阿托品眼用凝胶后的电脑验光值分别为(0.55±3.52)D和(2.22±3.52)D,差值为(1.66±1.62)D,差异有统计学意义(t=13.02,P=0.00);应用1％硫酸环戊通滴眼液后电脑验光值为(1.74±3.46)D,与应用1％阿托品后的电脑验光值相比差值为(0.48±0.46)D,差异有统计学意义(t=13.08,P=0.00).两种药物散瞳后的电脑验光值之间呈明显的阳性相关(R2=0.98,P=0.00).利用红外线验光仪测量残余调节,1％环戊通滴眼液和1％阿托品凝胶散瞳后测量的残余调节值分别为(0.32±0.44)D和(0.05±0.41)D,差值为(0.27±0.55)D,差异有统计学意义(t=4.56,P=0.00).按屈光类型分为近视组、低中度远视组和高度远视组,两种药物散瞳后电脑验光的差值近视组为(0.31±0.37)D,低中度远视组为(0.56±0.48)D,高度远视组为(0.59±0.50)D;近视组明显低于低中度远视组,差异有统计学意义(t=-3.14,P=0.00).4～6岁组两种药物散瞳后电脑验光的差值为(0.61±0.53)D,7～9岁组差值为(0.49±0.39)D,两组间差异无统计学意义(t=1.21,P=0.23).因“调节”隐藏的屈光度值与两种药物散瞳后电脑验光的差值呈弱相关(r=0.43,P=0.00). 结论 1％硫酸环戊通滴眼液点眼和1％硫酸阿托品眼用凝胶点眼对低龄儿童均能起到使调节放松的作用,两种药物的差值主要表现在远视儿童中.因此临床上对于远视儿童的散瞳验光最好应用1％硫酸阿托品眼用凝胶.     

盐酸环喷托酯滴眼液在儿童屈光状态检查中的应用

目的：探讨10 g/L盐酸环喷托酯滴眼液在小儿屈光状态检查中的应用。比较其与阿托品在散瞳验光中麻痹睫状肌的效果,用以指导临床工作。
　　方法：采用自身配对设计方法,对年龄3~12岁118例236眼(其中近视40例80眼,远视78例156眼,合并有散光73例146眼)先采用10 g/L盐酸环喷托酯滴眼液滴眼3次散瞳(每次间隔5min),末次点眼1h后进行检影验光。间隔3d后重新点10g/L阿托品眼膏1wk(每晚1次)重新进行散瞳检影验光。按屈光度分成近视组、远视组、散光组,其中散光度数是将柱镜度数独立分离出来统计。将两种散瞳药的验光结果进行比较。
　　结果：近视组使用两种方法散瞳验光后屈光度值分别为-2.25±1.31D,-2.23±1.32D,差异无统计学意义( P=0.109);远视组应用两种药物散瞳验光后屈光度分别为3.76±2.4D,4.39±2.6D,差异有统计学意义(P=0.000);散光组应用两种药物散瞳验光后屈光度值分别为1.35±1.19D,1.38±2.00D,差异无统计学意义(P=0.374)。
　　结论：盐酸环喷托酯滴眼液可用于临床上3~12岁近视、散光儿童的散瞳验光。但在远视儿童初次就诊仍需点阿托品眼膏散瞳验光。     

盐酸环喷托酯滴眼液在近视儿童散瞳验光中的应用

目的分析1%盐酸环喷托酯滴眼液（赛飞杰）对3-12岁近视儿童散瞳验光的结果,探讨其在3-12岁近视儿童散瞳验光中应用的可行性。方法对58例（116只眼）年龄3-12岁近视儿童患者,分别用1%盐酸环喷托酯滴眼液和1%阿托品眼膏散瞳验光,比较两种方法的验光结果。结果 1%盐酸环喷托酯滴眼液与1%阿托品眼膏散瞳后球镜值和柱镜值差异无显著性,P0.05。球镜值在116只眼中,结果相同或相差≤0.50D者114只眼,相差≥0.75D者2只眼,球镜值符合率为98.28%。柱镜值在68只眼中,结果相同或相差≤0.25D者67只眼,相差≥0.75D者1只眼,符合率为98.53%。各年龄组球镜值和柱镜值符合率均在95%以上,差异无统计学意义,P0.05。结论 1%盐酸环喷托酯滴眼液是一种安全有效的睫状肌麻痹剂,可用于3-12岁近视儿童散瞳验光。     

应用托吡卡胺与阿托品眼液对青少年远视散瞳验光的对比研究

目的对比托吡卡胺与阿托品眼液对青少年远视散瞳验光的结果。方法用托吡卡胺与阿托品眼液对143眼青少年远视进行散瞳视网膜检影验光。结果143眼远视球镜度数两次验光结果相同和相差≤0.50D者93眼、相差0.75D以上者50眼、远视球镜度数符合率为65.0%,78眼复性远视柱镜度数2次验光结果相同和相差≤0.50D者为71眼、相差0.75D以上者7眼、复性远视柱镜度数符合率为91.0%,散光轴向符合率为82.1%。本组资料2种不同散瞳剂散瞳验光结果对比远视球镜或复性远视柱镜度数相差0.75D以上者均为托吡卡胺低于阿托品散瞳验光的度数。结论青少年远视患者睫状肌调节力大,对青少年远视患者应用托吡卡胺散瞳验光仍可存留部分调节的隐性远视的屈光度数。阿托品眼液用于青少年远视散瞳验光麻痹睫状肌彻底,可暴露全部的远视度数。对青少年远视仍以阿托品眼液散瞳验光为宜。     

美多丽对远视眼学龄儿童验光的实用性探讨

目的探讨美多丽能否用于学龄儿童远视眼散瞳验光.方法以自身对照法,比较美多丽与1%阿托品用于33例60眼,6～12岁远视性屈光不正儿童,散瞳验光的结果.球、柱镜相同或相差≤0.50D为符合,＞0.50D为不符合;散光轴相同或相差≤5.为符合,＞0.50D为不符合.以student's配对t检验进行统计学分析.结果美多丽与98.33%,无显著差异(P86.67%,差异显著(P＜0.05);柱镜值符合率为1%阿托品散瞳验光结果,球镜值符合率为＞0.05);散光轴符合率为95.00%,无显著差异(P＞0.05).结论美多丽可用于无内斜视的远视性屈光不正学龄儿童散瞳验光,特别是再次散瞳验光配镜者.     

青少年儿童屈光参差临床分析

目的:探讨青少年儿童各类屈光参差分布,及各类屈光参差性弱视的治疗。方法:用阿托品扩瞳1wk后检影验光,两眼屈光参差≥3.00D的青少年儿童120例,年龄3～20(平均8)岁。在扩瞳情况下配镜治疗。结果:单纯远视性屈光参差75例,参差范围 3.00～ 8.50(平均 4.00)D,单纯近视性屈光参差32例,参差范围-3.00～-21.00(平均-6.50)D,远视散光性屈光参差2例,参差范围 3.25～ 4.75(平均 4.00)D,近视散光性屈光参差11例,参差范围-3.00～5.00(平均-4.00)D。结论:青少年儿童屈光参差以单纯远视性屈光参差多见,单纯近视性屈光参差范围较大,在扩瞳情况下,带镜均能接受,弱视治疗有不同程度效果。     

Cycloplegic effectiveness of cyclopentolate and tropicamide preparations compared with atropinization

To gain a comparative estimate of cycloplegic agents with mild effect vs conventional atropinization, a study was performed on refraction in 57 children after instillations of cyclopentolate and atropine and in 57 children after instillations of tropicamide and atropine. A difference was determined in refraction after instillation of cycloplegic agents with mild effect and atropine. It turned out that by depth of cycloplegic effect cyclopentolate is reaching that of atropine. Cyclopentolate can be used in initial study of refraction in children with hypermetropic and myopic refraction and in repeated studies of any refraction. Tropicamide is less effective cycloplegic agent than cyclopentolate and thus it can be used in initial studies of refraction in children with myopia and in repeat studies of refraction in children with myopia and hypermetropia and also in cases of intolerance of other cycloplegic agents.     

Changes of intraocular pressure and refractive status in children following cycloplegic refraction with 1% cyclopentolate and 1% tropicamide

Purpose:

To evaluate the effect of cycloplegic mydriasis with 1% cyclopentolate and 1% tropicamide on the intraocular pressure (IOP) and refractive status of children for cycloplegic refraction and compare the [OP and refractive changes between hyperopic and myopic groups.

Methods:

This study was designed as a retrospective cohort study. Ninety one children received cycloplegic mydriasis. The IOP was measured with a noncontact tonometer before cycloplegic administration. One drop of 1% cyclopentolate was administered, which was followed by two drops of 1% tropicamide at an interval of 10 minutes. The IOP was then measured 30 minutes after tropicamide instillation. Autorefraction was assessed with an autorefractometer before and after cycloplegic mydriasis.

Results:

The mean age of the 44 girls and 47 boys was 7.3 ± 2.4 years. The mean precycloplegic IOP was 14.45 ± 2.47 mmHg and the mean postcycloplegic IOP was 15.06 ± 3.08 mmHg in all eyes. A significant difference was noted in the IOP change (p = 0.033). In the 39 hyperopic eyes, the mean precycloplegic IOP and postcycloplegic IOP were 14.54 ± 2.53 mmHg and 15.69 ± 3.35 mmHg, respectively. There was a significant difference in the IOP change (p = 0.008). In the 52 myopic eyes, the mean precycloplegic IOP and postcycloplegic IOP were 14.38 ± 2.44 mmHg and 14.61 ± 2.80 mmHg, respectively (p = 0.72). There was no significant IOP change in the myopic group. The postcycloplegic IOP was significantly different between the hyperopic and the myopic groups (p = 0.021). Three eyes (3.3%) had an IOP elevation more than 5.0 mmHg after cycloplegic mydriasis. Postcycloplegic refraction showed significant hyperopic shifts in all eyes (p < 0.0001).

Conclusion:

Cycloplegic mydriasis with 1% cyclopentolate and 1% tropicamide caused IOP changes in preschool and school-aged children with hyperopia. Ophthalmologists should be very cautious in monitoring IOP changes for children with cycloplegic medication use.     

阿托品凝胶、盐酸环喷托酯和复方托吡卡胺睫状肌麻痹效果比较

目的：比较阿托品凝胶、盐酸环喷托酯和复方托吡卡胺在近视中小学生睫状肌麻痹验光中的效果,为科学验光和准确矫正提供理论依据。

方法：选取2017-07/08在我院经小瞳验光诊断为近视的中小学生420例818眼,按年龄分为3组,分别采用阿托品凝胶、盐酸环喷托酯和复方托吡卡胺进行睫状肌麻痹验光(散瞳验光)及小瞳复光。

结果：阿托品组、盐酸环喷托酯组、复方托吡卡胺组睫状肌麻痹验光与小瞳复光等效球镜符合率分别是：81.0%、81.3%和79.4%; 睫状肌麻痹验光与小瞳复光等效球镜之差阿托品组为-0.113±0.226D,差异有统计学意义(t=-4.663,P<0.001); 盐酸环喷托酯组为-0.025±0.192D,复方托吡卡胺组为-0.026±0.193D,差异均无统计学意义(t=-1.665,P=0.099; t=1.760,P=0.080)。

结论：对>8岁的近视中小学生,首次睫状肌麻痹验光可采用快速散瞳,以减少对学习生活的影响; 快速散瞳者复光配镜时可按小瞳结果直接给予处方,阿托品散瞳者小瞳复光近视屈光度高于散瞳时,配镜时需参考散瞳结果,选择最佳矫正视力的最低负镜度,避免近视过矫。     

Optimal dosage of cyclopentolate 1% for complete cycloplegia: a randomized clinical trial

PURPOSE: To determine the optimal dosage of cyclopentolate for adequate cycloplegia with minimal side effects. METHODS: A prospective randomized clinical trial of patients 3.5 to 20 years of age referred to a strabismus clinic during a 1-year period. Eligible patients were randomly divided into three groups. In Group 1, the cycloplegic effect of one drop of cyclopentolate was compared with two drops; in Group 2, the effect of two drops was compared with three drops; and in Group 3, the effect of one drop was compared with three drops. RESULTS: This study includes 192 eyes of 96 patients with a mean age of 11.0 +/- 5.7 years. Strabismus was present in 43 patients (44.8%). A total of 146 patients (76%) were hyperopic, 33 (17.2%) were myopic, and 13 (6.8%) were slightly hyperopic or myopic at the two stages of the study. Overall, only 16 eyes, including 9 eyes in Group 1 (16.4%), 2 eyes in Group 2 (3.2%), and 5 eyes in Group 3 (8.6%), had > or = 0.5 D difference in spherical equivalent refractive error at two stages of the study; however, intergroup differences were not statistically significant (p=0.16, chi-square test). Within each group, the percentage of eyes with <0.5 D difference was significantly greater than those with > or = 0.5 D difference (p<0.001 in all three groups, binomial test). Side effects were more prevalent using more frequent drops. CONCLUSIONS: A single drop of cyclopentolate 1% suffices for cycloplegic refraction. There were less frequent side effects using one drop of cyclopentolate, compared to two or three drops.     

托吡卡胺和阿托品对儿童散瞳验光应用价值的对比研究

目的探讨阿托品和托吡卡胺在儿童散瞳验光中的使用价值及对准确性的影响。方法儿童视力低常患者123例（246眼）,年龄4～12岁。按年龄分为两组,4～7岁组63例（126眼）,8～12岁组60例（120眼）。两组患者先用0.5%托吡卡胺散瞳,然后用NIDEKAR-600A电脑验光初测;第2天再用1%阿托品眼液滴眼,每日3次,连用3d,然后用同一电脑验光仪验光。分别记录两种方法散瞳后的验光结果,对比屈光度变化,采用SPSS11.0统计软件进行分析。结果托吡卡胺散瞳后,近视球镜均值比阿托品散瞳值高,远视球镜均值比阿托品值低,两组经配对t检验显示,差异有统计学意义（P＆lt;0.05）;柱镜均值与轴向均值经配对t检验显示,差异均无统计学意义（P＆gt;0.05）。两个不同年龄组等效球镜均值比较,不同散瞳方法差异有统计学意义（P＆lt;0.05）,托吡卡胺组等效球镜值均低于阿托品组。结论托吡卡胺用于儿童验光不是理想的选择,托吡卡胺不能代替阿托品。     

Cost-effectiveness of cycloplegic agents: results of a randomized controlled trial in nigerian children

PURPOSE: To compare the cost and effectiveness of three cycloplegic agents among Nigerian children. METHODS: Two hundred thirty-three children aged 4 to 15 years attending outpatient eye clinics in Nigeria were randomized to (1) 1% cyclopentolate, (2) 1% cyclopentolate and 0.5% tropicamide, or (3) 1% atropine drops in each eye (instilled at home over 3 days). Ten children were lost to follow-up, nine from the atropine group. An optometrist measured the residual accommodation (primary outcome), dilated pupil size, pupil response to light, and self-reported side effects (secondary outcomes). Caregivers were interviewed about costs incurred due to cycloplegia (primary outcome). The incremental cost effectiveness ratios (ICERs) were calculated as the difference in cost divided by the difference in effectiveness comparing two agents. The 95% confidence intervals (CI) for ICERs were estimated through bootstrapping. RESULTS: The atropine group had significantly lower mean residual accommodation (0.04 +/- 0.01 D [SE]), than the combined regimen (0.36 +/- 0.05 D) and cyclopentolate (0.63 +/- 0.06 D) groups (P < 0.001). Atropine and the combined regimen produced better results for negative response to light and dilated pupil size than cyclopentolate. Atropine was more expensive, but also more effective, than the other agents. The ICER comparing atropine to the combined regimen was 1.81 (95% CI = -6.31-15.35) and compared to cyclopentolate was 0.59 (95% CI = -3.47-5.47). The combined regimen was both more effective and less expensive than cyclopentolate alone. CONCLUSIONS: A combination of cyclopentolate and tropicamide should become the recommended agent for routine cycloplegic refraction in African children. The combined regimen was more effective than cyclopentolate, but not more expensive, and was preferable to atropine, since it incurred fewer losses to follow-up.     

儿童视力正常眼的屈光状态

目的了解儿童视力正常眼的屈光状态及其意义。方法儿童视光门诊中远近视力≥1.0的3～14岁儿童459名544只眼,均用1%阿托品眼膏散瞳,每晚涂眼一次,一周后由固定专职人员验光,记录结果。结果视力正常眼的屈光状态可见有远视、正视、近视和混合散光,其中远视420只眼,占77.2%;正视72只眼,占13.2%;近视30只眼,占5.5%;混合散光22只眼,占4.0%。表现有散光者309只眼,占56.8%。结论儿童视力正常眼不等于屈光正常,有必要进行静态屈光检查,了解基础屈光,发现潜在问题,预测视力与屈光的发展趋势,为早期干预提供依据。