盐酸环喷托酯滴眼液在儿童远视验光中的应用

目的：比较盐酸环喷托酯滴眼液和阿托品眼用凝胶在12岁以下远视儿童散瞳检影验光结果,以评估盐酸环喷托酯滴眼液在远视验光中的临床使用价值。

方法：年龄2～12岁的远视儿童51例102眼,先用10g/L盐酸环喷托酯滴眼液连续点眼5次后验光,间隔1d后,再用10g/L硫酸阿托品眼用凝胶连续点眼3d后进行散瞳检影验光。分析比较两种睫状肌麻痹剂在不同屈光组的验光结果及全身不良反应。

结果：轻度远视31眼两种验光结果无统计学差异(P>0.05),中度远视组39眼两种验光结果无统计学差异(P>0.05),高度远视组32眼两种验光结果无统计学差异(P>0.05)。10g/L盐酸环喷托酯滴眼液的全身不良反应发生率为2%,10g/L阿托品眼用凝胶全身不良反应发生率为8%。

结论：盐酸环喷托酯滴眼液是一种起效快、作用强、持续时间短的安全有效的新型睫状肌麻痹剂,临床上可广泛应用。     

盐酸环喷托酯对儿童睫状肌麻痹效果的观察

目的:探讨盐酸环喷托酯滴眼液对屈光不正儿童验光睫状肌麻痹的效果。方法:对6～12岁屈光不正儿童60例120眼随机分为3组,分别用盐酸环喷托酯滴眼液、复方托吡卡胺滴眼液及阿托品眼膏滴眼。在用药前及用药后不同时间点对3组患者分别在电脑验光仪上进行客观验光并测量瞳孔直径,在综合验光仪上进行主观验光并用移近法测量调节力和剩余调节力。结果:盐酸环喷托酯滴眼液最大睫状肌麻痹时间是60min,在最大睫状肌麻痹状态下盐酸环喷托酯组剩余调节力较复方托吡卡胺组小(P<0.05),与阿托品组相近(P>0.05)。结论:用盐酸环喷托酯代替阿托品对6～12岁屈光不正非斜视儿童进行散瞳验光是可行的。     

环喷托酯和阿托品对近视儿童睫状肌麻痹效应的Meta分析

目的:系统评价环喷托酯和阿托品应用于近视儿童验光前的睫状肌麻痹效应和安全性。方法:在PubMed、EMBASE、Web of Science、The Cochrane Library、中国知网(CNKI)、万方数据库中检索自建库至2020-04发表的关于比较环喷托酯与阿托品用于近视儿童睫状肌麻痹效果的相关文献。对于筛选出来的文献,经资料提取和质量评价后,采用RevMan5.3软件进行Meta分析。结果:本研究最终纳入9篇文献,其中使用阿托品者588眼,使用环喷托酯者592眼。Meta分析结果显示,近视儿童验光前使用环喷托酯和阿托品进行睫状肌麻痹后屈光度[WMD=-0.01,95%CI(-0.30,0.27),P=0.93]和残余调节力[WMD=0.22,95%CI(-0.13,0.58),P=0.22]均无差异,但环喷托酯不良反应发生率较低,更安全。结论:环喷托酯与阿托品对近视儿童的睫状肌麻痹作用相当,且安全性较高,可以替代阿托品对近视儿童在验光前使用。     

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和复方托品卡胺睫状肌麻痹效果比较

目的:了解盐酸环喷托酯滴眼液和复方托品卡胺滴眼液在散瞳验光中麻痹睫状肌的临床效果,客观地对其评价以指导临床工作。 方法:随机抽取2010-12/2011-03期间的60例120眼屈光不正（近视和远视各占50%）患者,年龄12～40岁,利用国产复方托品卡胺滴眼液滴眼散瞳先后对其进行散瞳4次, 45min以后,对其进行检影验光,并利用综合验光仪测定其残余调节量,第2d用盐酸环喷托酯眼液进行复验。 结果:远视组盐酸环喷托酯滴眼液和复方托品卡胺两者验光结果差异较大（P＜0.01）;近视组两者验光差异较小（P＜0.05）,但是仍然具有统计学差异。 结论:临床上对于屈光不正患者的屈光检查,复方托品卡胺滴眼液是一种有效的睫状肌麻痹剂,但因注意到其麻痹睫状肌及放松调节的有限性,特别在远视患者应灵活结合其他放松调节如盐酸环喷托酯眼液的方法获取最终的配镜处方。     

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。     

远视儿童应用1％环喷托酯睫状肌麻痹验光的研究

目的 探讨远视儿童应用1％环喷托酯滴眼液以及联合应用表面麻醉药丙美卡因滴眼液的远视屈光度的峰值时间,并比较应用1％环喷托酯与1％阿托品睫状肌麻痹验光的屈光度值的差异.方法 采用简单随机化分组方法将71例(141只眼)远视儿童[年龄(7.9±2.1)岁]分为A组(Pro +Cyc组)和B组(NS+ Cyc组).两组均于1...     

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。     

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。     

盐酸环喷托酯滴眼液在远视儿童散瞳验光中的应用

目的：研究盐酸环喷托酯滴眼液在远视儿童散瞳验光中的综合应用效果。方法：选取2014－02／2015－03于本院进行散瞳验光的84例远视儿童为研究对象,将其分别采用托吡卡胺和盐酸环喷托酯滴眼液进行散瞳验光,然后将两种方法的屈光度结果、给药前及给药后不同时间的瞳孔直径及残余调节量进行比较,并比较两种方法中不同严重程度者的检查结果。结果：两种检查方法的屈光度检查结果、给药前的瞳孔直径及残余调节量无统计学差异（P＞0．05）,而给药后20、40、60 min及24 h盐酸环喷托酯滴眼液的残余调节量均小于托吡卡胺（P＜0．05）,给药后60min两种方法的瞳孔直径无统计学差异（P＞0．05）,给药后48h两种方法的瞳孔直径均与给药前无统计学差异（P＞0．05）。结论：盐酸环喷托酯滴眼液在远视儿童散瞳验光中的综合应用效果较好,对于睫状肌麻痹的效果尤为明显。     

盐酸环喷托酯、复方托吡卡胺与阿托品对儿童睫状肌麻痹效果的比较

目的：探讨盐酸环喷托酯、复方托吡卡胺与阿托品对不同年龄、屈光状态及调节性内斜视儿童的睫 状肌麻痹效果。方法：前瞻性临床研究。对2018年9月至2019年9月在武汉大学人民医院眼科就诊 的3～12岁屈光不正儿童283例（566眼）行睫状肌麻痹验光。所有患儿均先使用1%阿托品眼用凝胶 点眼后电脑验光,并随机分为A组和B组。2组均按年龄分为3～<6岁组和6～<12岁组,3～<6岁组 和6～<12岁组再分为无内斜近视组、无内斜远视组和伴内斜视组3个亚组。5周后,瞳孔大小及对光 反射恢复正常,A组使用1%盐酸环喷托酯滴眼液点眼后电脑验光,B组使用0.5%复方托吡卡胺滴眼 液点眼后电脑验光。采用Wilcoxon符号秩和检验对1%阿托品睫状肌麻痹前后电脑验光等效球镜度 （SE）差值、不同药物睫状肌麻痹后电脑验光差值进行统计分析。结果：1%阿托品散瞳后SE较散瞳 前偏正,SE差值为1.75（1.00～2.75）D,差异有统计学意义（Z=-20.62,P<0.001）。差异在3～<6岁 儿童、无内斜远视儿童及伴内斜视儿童中更明显（P<0.001）。A组使用1%阿托品散瞳后SE较使用 1%盐酸环喷托酯后偏正,SE差值为0.25（0.13～0.50）D（Z=-11.49,P<0.001）。3～<6岁组使用1% 阿托品后和使用1%盐酸环喷托酯后的SE差值在无内斜近视组、无内斜远视组和伴内斜视组分别为 0.25（0.25～0.25）D、0.38（0.25～0.50）D、0.50（0.38～0.75）D（Z=-3.34、-7.36、-4.95,均 P<0.001）。6～<12岁组的SE差值在3组为0（0～0.12）D、0.25（0.12～0.25）D、0.44（0.28～0.69）D （Z=-0.83,P=0.405;Z=-5.30,P<0.001;Z=-3.53,P<0.001）。B组使用1%阿托品散瞳后SE较使用0.5% 复方托吡卡胺后偏正,SE差值为0.25（0.13～0.50）D（Z=-15.46,P<0.001）。3～<6岁组使用1%阿 托品后和使用0.5%复方托吡卡胺后的SE差值在无内斜近视组、无内斜远视组和伴内斜视组分别为 0.25（0.19～0.25）D、0.38（0.25～0.75）D、0.69（0.30～1.03）D（Z=-3.15,P=0.002,Z=-9.89, P<0.001,Z=-4.79,P<0.001）。6～<12岁组的SE差值在3组分别为0（0～0.12）D、0.32（0.13～0.38）D、 0.50（0.41～0.50）D（Z=-1.37,P=0.171;Z=-7.15,P<0.001;Z=-4.37,P<0.001）。结论：1%盐酸环 喷托酯滴眼液或0.5%复方托吡卡胺滴眼液点眼后散瞳验光SE与1%阿托品眼用凝胶点眼后散瞳验光 的SE在6～<12岁无内斜视的近视儿童中相近,在3～<6岁和6～<12岁远视及伴内斜视儿童中存在 差异。     

Comparison of Cyclopentolate,Compound Tropicamide and Atropine on Cycloplegiain Children

Objective: To investigate and compare the cycloplegic effect of cyclopentolate, compound topicamide and atropine in children with different ages, refractive status and accommodative esotropia. Methods: This prospective clinical study had been conducted at Renmin Hospital of Wuhan University between September 2018 and September 2019 in 283 children (566 eyes) of 3-12 years old with refractive error. All the children were given 1% atropine to obtain the refractive diopter, and they were randomly divided into group A and group B. The two group are divided into 3-<6 years old group and 6-<12 years old group according to age. The 3-<6 years old group and the 6-<12 years old group are divided into three subgroups: The myopia group without esotropia, the hyperopia group without esotropia and the esotropia group. After 5 weeks, pupil size and light reflex back to normal. Group A received 1% cyclopentolate hydrochloride eye drops for computer optometry, and group B received 0.5% compound tropicamide eye drops for computer optometry. The Wilcoxon signed rank sum test was used to statistically analyze the difference of spherical equivalent of computer optometry before and after 1% atropine, and the difference of computer optometry after different cycloplegia. Results: The SE after 1% atropine was greater than before 1% atropine, the difference of SE was 1.75(1.00-2.75)D, and the difference was statistically significant (Z=-20.62, P<0.001). The difference was more obvious children with aged 3 to 6, children with hyperopia and children with esotropia (P<0.001). In group A, the SE after using 1% atropine was greater than that after using 1% cyclopentolate, and the difference of SE was 0.25(0.13-0.50)D (Z=-11.49, P<0.001). The difference of SE in 3-<6 years old group after using 1% atropine and 1% cyclopentolate in the myopia group without esotropia, hyperopia group without esotropia and esotropia group were 0.25(0.25-0.25)D, 0.38(0.25-0.50)D, 0.50(0.38-0.75)D (Z=-3.34, -7.36, -4.95, all P<0.001). The difference of SE of that 3 subgroups in the 6-<12 years group were 0(0-0.12)D, 0.25(0.12-0.25)D, 0.44(0.28-0.69)D (Z=-0.83, P=0.405; Z=-5.30, P<0.001; Z=-3.53, P<0.001). In group B, the SE after using 1% atropine was greater than that after using 0.5% compound tropicamide, and the difference of SE was 0.25(0.13-0.50)D (Z=-15.46, P<0.001). The difference of SE in 3-<6 years old group after using 1% atropine and 0.5% compound tropicamide in the myopia group without esotropia, hyperopia group without esotropia and esotropia group were 0.25(0.19- 0.25)D, 0.38(0.25-0.75)D, 0.69(0.30-1.03)D (Z=-3.15, P=0.002; Z=-9.89, P<0.001; Z=-4.79, P<0.001). The difference of SE of that 3 subgroups in the 6-<12 years group were 0(0-0.12)D, 0.32(0.13-0.38)D, 0.50(0.41-0.50)D (Z=-1.37, P=0.171; Z=-7.15, P<0.001; Z=-4.37, P<0.001). Conclusions: The spherical equivalent of mydriasis refraction with 1% cyclopentolate eye drops or 0.5% compound tropicamide eye drops is similar to that with 1% atropine in myopic children aged 6 to 12 years without esotropia, and it is different from that with 1% atropine in 3-<6 years old children and children with hyperopia and esotropia at 6-<12 years old.     

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.     

The comparison of cyclopentolate and atropine in patients with refractive accommodative esotropia by means of retinoscopy, autorefractometry and biometric lens thickness.

PURPOSE: In this study, we aimed to compare the cycloplegic effect of cyclopentolate HCI 1% and atropine sulphate 1% in patients with refractive accommodative esotropia by means of retinoscopy, autorefractometer and the measurement of lens thickness by biometry. METHODS: Thirty-two patients with refractive accommodative esotropia aged from 5 to 10 (mean 6.8+/-1.4), had a deviation under 10 prism diopters, and underwent retinoscopic, autorefractometric and biometric study in dry and wet conditions. RESULTS: The retinoscopic, autorefractometric and biometric findings of the right eye were 5.10+/-1.21 diopter (D), 5.03+/-1.20 D, 3.43+/-0.16 mm with cyclopentolate, and 5.2+/-1.2 D, 5.2+/-1.2 D, 3.4+/-0.1 mm with atropine. In the left eye, the measurements were 5.2+/-1.4 D, 5.1+/-1.4 D, 3.5+/-0.2 mm with cyclopentolate, and 5.3+/-1.2 D, 5.20+/-1.3 D, 3.4+/-0.2 mm with atropine, respectively. When these obtained data were compared by the Student's t test no statistical significance was found (p > 0.05). CONCLUSIONS: We suggest that the cyclopentolate cycloplegia applied to the patients with refractive accommodative esotropia is sufficient to produce good cycloplegia, with an effect similar to atropine.     

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.     

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.     

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.