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。     

盐酸环喷托酯和阿托品对远视儿童睫状肌麻痹效果的比较

目的:比较盐酸环喷托酯与阿托品对远视儿童睫状肌麻痹效果,以评估盐酸环喷托酯的临床使用价值。方法:对96例192眼远视儿童进行观察,先用盐酸环喷托酯滴眼液,后用阿托品眼膏,分析比较两种药物睫状肌麻痹后的验光结果和观察药物的不良反应。结果:两组睫状肌麻痹后的验光结果差异无显著性(P>0.05)。盐酸环喷托酯组未见明显药物不良反应,低于阿托品组(12.5%)。结论:盐酸环喷托酯是一种强效、快速且安全的睫状肌麻痹剂,值得临床推广应用,尤其适合远视儿童的睫状肌麻痹验光检查。     

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。     

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。     

国产盐酸环喷托酯滴眼液和托吡胺对眼睫状肌麻痹效果的比较研究

目的:观察国产盐酸环喷托酯滴眼液对人眼睫状肌麻痹和瞳孔散大的效果。方法:入选者48例左右眼随机分入试验组和对照组,分别滴用10g/L盐酸环喷托酯滴眼液和托吡卡胺滴眼液,每次1滴,隔5min再滴1次。于给药前1/6,给药后1/3,3/4,5/4,24,48h检查瞳孔直径和残余调节量。结果:国产盐酸环喷托酯的散瞳效应较托吡卡胺弱(P<0.01),但持续时间较长(P<0.01);盐酸环喷托酯的麻痹睫状肌效应较托吡卡胺强(P<0.01),持续时间也较长(P<0.01)。结论:盐酸环喷托酯滴眼液是一种安全有效的睫状肌麻痹剂,其麻痹睫状肌的效果优于托吡卡胺。     

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。     

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。     

不同睫状肌麻痹剂对儿童调节力及屈光状态的影响

目的 找出美多丽P滴眼液、罗米滴眼液最大睫状肌麻痹时间,对比美多丽P滴眼液、罗米滴眼液、1%阿托品眼膏最大睫状肌麻痹时的剩余调节力,并分析3种药物对屈光不正检测的影响.为眼科临床上合理应用睫状肌麻痹剂提供一定的实验依据.方法 对4～16岁儿童75例、147只眼进行检查,均未曾配戴眼镜,未曾屈光治疗,其裸眼或矫正视力均可达1.0,并除外其他眼病及影响调节的全身病.按3种药物分3组,对其睫状肌麻痹前后不同时间点分别进行手持自动电脑验光仪客观验光,视网膜检影验光,在综合验光仪上主观验光,在其上用移近法测量调节力及剩余调节力.结果 (1)最大睫状肌麻痹时间罗米为60min,美多丽P为30min,次日均可以正常阅读.(2)最大睫状肌麻痹时平均剩余调节力:1%阿托品组(2.0440±0.95484)D,罗米组(2.2214±0.6952)D,美多丽P组(2.6656±0.9999)D.两独立样本t检验前两组无显著差异,美多丽P组与前两组差异显著,尤其近视时剩余调节力偏大.(3)三组剩余调节力均与屈光状态及年龄无关.(4)1%阿托品、罗米、美多丽P三组中每组药物最大睫状肌麻痹后,综合验光仪验光、视网膜检影结果无差别,都能达到主、客观验光结果的一致性.结论 罗米滴眼液、美多丽P滴眼液在临床上可以作为近视及远视验光的有效睫状肌麻痹剂.     

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.     

Dilation efficacy: Is 1% cyclopentolate enough?

BACKGROUND: Pediatric eye examinations include cycloplegia and dilation. Most clinicians use 2 or 3 different medications in drop or spray form to ease instillation. We studied whether a single drop of a cycloplegic agent would provide effective dilation as well. METHODS: Children between the ages of 1 and 7 years, who presented for a routine eye examination, were recruited to participate. Each child received 1% cyclopentolate in the right eye (group A), and either tetracaine with cyclopentolate (group B) or tetracaine with cyclopentolate with phenylephrine (group C) in the left eye. At the completion of the examination, a digital picture was taken of the patient's pupils. A separate observer measured the pupil diameter and classified iris color. RESULTS: The mean pupil size for all subjects was: 6.19 mm +/- 1.33 mm, for group A, 6.56 mm +/- 1.25 for group B; and 6.47 mm +/- 1.12 for group C. Light-colored iris patients had greater dilation as a group and darker iris patients had less dilation as a group. Evaluation of the paired eyes pupil diameter found no statistical difference. CONCLUSIONS: One drop of 1% cyclopentolate provides cycloplegia and effective pupil dilation for completion of a pediatric eye examination. One drop is easier to instill than multiple drops and should be considered for use in a pediatric eye examination.     

Comparison of tropicamide and cyclopentolate for cycloplegic refractions in myopic adult refractive surgery patients

PURPOSE: To compare tropicamide 1%, a shorter-acting cycloplegic agent, with cyclopentolate 1% for cycloplegic refractions in adult refractive surgery patients. SETTING: Navy Refractive Surgery Center, Ophthalmology, Naval Medical Center, San Diego, California. METHODS: The study was prospective, single center, with randomized sequencing of cycloplegic agent; each patient received both agents. Thirty consecutive myopic adult refractive surgery patients (mean age 35.4 years) participated. A complete preoperative examination, including cycloplegic refraction, was obtained twice, 1 week apart. The patient and the examiner were masked to the medication. Main outcome measures included cycloplegic and manifest refractions, best corrected distance acuity, near-point accommodation, pupil diameters, and subjective appraisal of experience with cycloplegic agents. RESULTS: Twenty-eight of 30 patients completed both examinations. Both eyes were measured, but comparisons were limited to right and left eyes, independently. No statistically significant difference was found between the tropicamide and cyclopentolate cycloplegic refractions (mean difference in MSE +/- SD, OD=0.054 +/- 0.214 diopters (D), t=1.33, P=.10; OS=0.054 +/- 0.253 D, t=1.12, P=.14). Five eyes of 3 patients had a difference of 0.50 D or greater between the 2 agents; less myopia with cyclopentolate. Near-point testing revealed less residual accommodation with cyclopentolate (difference in MSE, OD=-0.27 +/- 0.51 D, t=2.68, P=.006; OS=-0.32 +/- 0.49 D, t=3.46, P=.001). Subjectively, 24 of 28 (86%) patients preferred tropicamide, 1 (4%) preferred cyclopentolate, and 3 (10%) had no preference. CONCLUSIONS: There was no statistically significant difference in mean cycloplegic refractions. Cyclopentolate was more effective than tropicamide in reducing accommodative amplitude in adult myopes (near-point testing). Patients strongly preferred tropicamide.     

Validity of noncycloplegic refraction in the assessment of refractive errors: the Tehran Eye Study

Purpose: To determine the sensitivity and specificity of noncycloplegic autorefraction for determining refractive status compared to cycloplegic autorefraction. Methods: The target population was noninstitutionalized citizens of all ages, residing in Tehran in 2002, selected through stratified cluster sampling. From 6497 eligible residents, 70.3% participated in the study, from August to November 2002. Here, we report data on 3501 people over the age of 5 years who had autorefraction with and without cycloplegia (two drops of cyclopentolate 1.0% 5 min apart, with autorefraction 25 min after the second drop). Results: Overall, the sensitivity of noncycloplegic autorefraction for myopia was 99%, but the specificity was only 80.4%. In contrast, the sensitivity for hyperopia was only 47.9%, but the specificity was 99.4%. At all ages, noncycloplegic autorefraction overestimated myopia and underestimated hyperopia. Overestimation of myopia was highest in the 21–30 and 31–40 year groups. Underestimation of hyperopia was high up to the age of 50 (20–40%), but decreased with age, to about 8% after the age of 50, down to almost 0% after 70. The difference in mean spherical equivalent with and without cycloplegia fell from 0.71 dioptres (D) in the 5–10 age group to 0.14D in those over 70. Conclusion: Use of noncycloplegic autorefraction in epidemiological studies leads to considerable errors relative to cycloplegic measurements, except in those over 50–60. The difference between cycloplegic and noncycloplegic measurements varies with age and cycloplegic refractive category, and there is considerable individual variation, ruling out adjusting noncycloplegic measurements to obtain accurate cycloplegic refractions.     

EFFECTS OF 0.1% CYCLOPENTOLATE OR 10% PHENYLEPHRINE ON PUPIL DIAMETER AND ACCOMMODATION

The mydriatic and cycloplegic effects of either one drop of 0.1% cyclopentolate or two drops of 10% phenylephrine were studied over a period of up to 6 hours after drug instillation, using 5 subjects aged between 25 and 43 years. The extent of mydriasis was determined from the horizontal diameter of the pupil. Dynamic accommodation responses were monitored with an infra-red, continuously recording optometer. Static measurements of the accommodation response/stimulus curve were made with a laser optometer. With either drug, dilation of the pupil occurred more rapidly than recovery of normal pupil diameter. Both drugs caused alterations in the dynamic and static accommodation responses. Response times were generally slowed, and the slope of the accommodation response/stimulus curve and the amplitude of accommodation were reduced. The time course of these changes was broadly similar to that of the pupil dilation. Cyclopentolate hydrochloride was more efficient as a mydriatic but exercised a greater unwanted cycloplegic effect.