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。     

1%阿托品和复方托品酰胺在远视儿童检影比较

目的 比较1%阿托品眼膏和复方托品酰胺眼液在远视儿童散瞳检影的结果,探索复方托品酰胺在远视儿童散瞳检影的应用范围.方法 用1%阿托品眼膏和复方托品酰胺眼液对166例(300只眼)远视儿童分别散瞳后进行视网膜检影验光,对两种药物散瞳检影所得结果采用自身配对t检验,用SPSS 12.0统计学软件进行数据处理.结果 12～15岁轻度远视组两种药物散瞳检影所得结果差异无统计学意义(P＞0.05);4岁～和8岁～各组及12～15岁中度、高度组两种药物检影所得结果差异有统计学意义(P＜0.05).结论 12～15岁轻度远视患儿可用复方托品酰胺进行散瞳检影.12岁以下学龄儿童及12～15岁中度、高度远视患儿应以阿托品散瞳检影;在不能使用阿托品检影的特殊情况可用复方托品酰胺散瞳检影.学龄前和伴内斜的远视儿童应用阿托品散瞳检影.     

复方托吡卡胺和阿托品在儿童验光检查中的应用研究

目的探讨复方托吡卡胺滴眼液和阿托品眼用凝胶在儿童验光检查中的应用效果及其相关性。 方法收集2016年1月至2019年3月于首都医科大学附属北京同仁医院眼科中心就诊儿童151例(302只眼)的资料。其中,男性68例(136只眼),女性83例(166只眼);年龄3~10岁,平均年龄(6.0±1.5)岁。根据屈光状态将患儿分为远视眼组、混合散光组及近视眼组。各组患儿均先后进行复方托吡卡胺和阿托品散瞳,而后检查并记录患儿的球镜值、柱镜值、轴向值及最佳矫正视力。所有指标经Kolmogorov-Smirnov正态性检验,不符合正态分布时,以中位数和四分位数描述。组内比较采用配对样本秩和检验。不同年龄患儿两种药物散瞳验光结果中球镜差值的比较,采用独立样本秩和检验。患儿两种药物散瞳验光结果中球镜值间的关系,采用一元线性回归进行分析。 结果远视眼组、混合散光组及近视眼组患儿分别有63例(126只眼)、41例(82只眼)和47例(94只眼)。三组患儿性别间的比较,差异无统计学意义(χ²＝0.171,P>0.05);三组患儿年龄间的比较,差异无统计学意义(F＝1.399,P>0.05)。远视眼组患儿复方托吡卡胺散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为2.50(1.00,5.31)D、1.00(0.50,1.75)D、90(85,100)°及0.10(0.00,0.20);阿托品散瞳验光结果中的球镜值、柱镜值、轴向值及矫正视力分别为3.50(2.00,6.31)D、1.00(0.50,1.75)D、90(85,95)°及0.10(0.00,0.20)。经配对样本秩和检验,各组患儿球镜值、柱镜值及最佳矫正视力的比较,差异有统计学意义(Z＝9.692,-2.726,-2.483;P<0.05);但轴向值的比较,差异无统计学意义(Z＝-0.173,P>0.05)。混合散光组患儿复方托吡卡胺散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-1.00(-2.00,-0.75)D、3.00(2.00,4.00)D、90(85,95)°及0.10(0.00,0.20);阿托品散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-0.50(-1.25,0.00)D、3.00(2.00,4.00)D、90(85,95)°及0.10(0.00,0.20)。经配对样本秩和检验,各组患儿球镜值和最佳矫正视力的比较,差异有统计学意义(Z＝7.778,-2.826;P<0.05);但柱镜值和轴向值的比较,差异无统计学意义(Z＝-1.098 ,-0.653;P>0.05)。近视眼组患儿复方托吡卡胺散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-3.50(-6.00,-1.25)D、-1.38(-2.50,-0.50)D、90(85,95)°及0.00(0.00,0.20);阿托品散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-3.13(-5.25,-1.00)D、-1.50(-2.50,-0.50)D、90(85,95)°及0.10(0.00,0.20)。经配对样本秩和检验,各组患儿球镜值和最佳矫正视力的比较,差异有统计学意义(Z＝8.388,-2.744;P<0.05);但柱镜值和轴向值的比较,差异无统计学意义(Z＝0.511,-1.735;P>0.05)。远视眼组、混合散光组及近视眼组患儿两种药物散瞳验光结果中的球镜值函数关系分别为y_阿托品＝1.068+0.976x_{复方托吡卡胺}、y_阿托品＝0.775+0.999x_{复方托吡卡胺}及y_阿托品＝0.248+0.949x_{复方托吡卡胺}。远视眼组、混合散光组及近视眼组<6岁患儿的球镜差值分别为1.00(0.75,1.44)D、1.00(0.50,1.25)D及0.50(0.25,0.75)D;≥6岁患儿的球镜差值分别为0.75(0.50,1.00)D、0.50(0.25,0.75)D及0.25(0.00,0.50)D;经独立样本秩和检验,组内两者的比较差异有统计学意义(Z＝-2.261,-4.160,-2.360;P<0.05)。 结论各组两种药物散瞳后,年龄越小者验光结果差异越大。远视眼和混合散光患儿应采用阿托品散瞳验光,在特殊情况下对混合散光和年龄≤6岁的近视眼患儿可在复方托吡卡胺散瞳验光结果的基础上,再根据两者的函数关系修正为阿托品的验光结果,6岁以上近视眼患儿建议采用复方托品卡胺散瞳验光。     

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。     

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。     

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。     

托吡卡胺与阿托品眼液在屈光不正性弱视儿童散瞳验光时的对比

目的　探讨托吡卡胺在屈光不正性弱视儿童散瞳验光中的适用范围。方法　对 14 1例 (2 82只眼 )屈光不正性弱视儿童前后用两种药物 (托吡卡胺与阿托品眼液 )散瞳验光结果进行对比。结果　远视患儿中两种药物散瞳验光符合率为 2 7.5 5 % ,近视患儿中符合率为 82 .5 6 %。结论　托吡卡胺不能用于远视 ,特别是远视合并内斜弱视患儿的散瞳验光 ;但它是较大近视性弱视儿童散瞳验光的理想药物     

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。     

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。     

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.     

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。     

环喷托酯单独用药和环喷托酯-复方托吡卡胺联合用药的睫状肌麻痹效果比较

目的：比较6～12岁儿童单独使用1%环喷托酯和1%环喷托酯-复方托吡卡胺联合用药的睫状肌麻痹 效果。方法：前瞻性随机对照研究。2018年7─9月在北京市海淀区妇幼保健院进行睫状肌麻痹验光 的6～12岁屈光不正儿童98例（98眼）,根据随机数字表法随机分为单独用药组和联合用药组。单独 用药组给予1%环喷托酯点眼3次;联合用药组给予1%环喷托酯点眼3次和复方托吡卡胺点眼2次。 分别于点眼前,第1次点眼后30、45、75 min测量等效球镜度（SE）和瞳孔直径。使用独立样本t检验 比较2组基线数据。采用重复测量资料的方差分析对不同给药方法在不同时间SE和瞳孔直径的影响 进行分析。使用Pearson相关性分析睫状肌麻痹程度与瞳孔散大程度之间的关系。结果：2组SE值均 在点眼后30 min内向正值方向发展,45 min达到最佳效果,45～75 min基本保持平稳,不同时间点睫 状肌麻痹作用差异有统计学意义（F=57.06,P<0.001）。不同给药方式对睫状肌麻痹效果影响差异无 统计学意义。随时间延长,不同给药方式睫状肌麻痹效果差异无统计学意义。点眼后2组瞳孔直径 均随时间延长而增大,时间因素引起瞳孔直径变化差异有统计学意义（F=502.87,P<0.001）。联合用 药组瞳孔直径大于单独用药组（F=30.63,P<0.001）,随时间延长,联合用药组瞳孔直径均大于单独 用药组,差异有统计学意义（F=13.53,P<0.001）。2组点眼后75 min SE改变值与瞳孔直径增加值之 间均无相关性。结论：在我国6～12岁儿童中,1%环喷托酯-复方托吡卡胺联合用药在睫状肌麻痹效 果、起效时间以及持续时间方面均未优于1%环喷托酯单独用药,而联合用药后瞳孔散大的不良反 应明显大于单独用药。     

Comparative Study on Cycloplegia with Cyclopentolate Alone and Cyclopentolate Combined with a Tropicamide Compound

Objective: To study cycloplegia using 1% cyclopentolate alone and 1% cyclopentolate combined with a tropicamide compound in children aged 6-12 years. Methods: In this prospective randomized controlled study, 98 children aged 6-12 years with ametropia were randomly divided into two groups: One group was given 1% cyclopentolate 3 times, the other group was given 1% cyclopentolate 3 times and a tropicamide compound 2 times. The spherical equivalent and pupil diameter were measured before and 30 min, 45 min and 75 min after the first eyedrop. The baseline data of the 2 groups were compared by an independent-samples t test. ANOVA of repeated measures was used to analyze the influence of the different methods on thesphericity equivalent (SE) and pupil diameter at different times. The correlation between the degree of cycloplegia and mydriasis was analyzed by Pearson correlation analysis. Results: The negative sphericity of the two groups decreased rapidly within 30 minutes after the first drop, the best effect was achieved in 45 minutes, and remained stable from 45 minutes to 75 minutes. The cycloplegia between different time points were statistically different (F=57.06, P<0.001) but there was no significant difference between the 2 methods. As time progressed, the difference in cycloplegia between the 2 methods was not significant. The pupil diameter of the 2 groups increased with the progression of time and was statistically significant (F=502.87, P<0.001). The pupil diameter of the group with the compound was larger than that of the single group (F=30.63, P<0.001), and as time progressed, the difference was also statistically significant (F=13.53, P<0.001). There was no correlation between the decrease in the negative SE and the increase in pupil diameter in the 2 groups. Conclusions: In children aged 6-12 years, the cycloplegia effect, onset time and duration of 1% cyclopentolate combined with a tropicamide compound are not better than that of 1% cyclopentolate alone, but mydriasis with the compound is significantly greater than 1% cyclopentolate alone.     

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.     

Comparative study on the safety and efficacy of different cycloplegic agents in children with darkly pigmented irides

BACKGROUND: The ideal cycloplegic drug that is safe, effective and convenient in children is not yet available. This study aimed to evaluate the safety and efficacy of three cycloplegic regimens in hyperopic children with pigmented irides. The responses to cycloplegia in different age groups and presence of strabismus were also compared. METHODS: Tropicamide 0.5% and phenylephrine 0.5% (regimen I), tropicamide 1.0% and cyclopentolate 1.0% (regimen II), and atropine 1.0% (regimen III) were evaluated in 25 children using a crossover study design. Cycloplegic refractions were assessed. RESULTS: The mean age of the children was 5.7 +/- 2.0 years (range 2.5-10.8 years). Six (24.0%) of them had strabismus. The spherical equivalent (SE) refraction for regimens I, II and III were +5.11 +/- 2.04 D, +5.29 +/- 1.89 D and +5.71 +/- 1.90 D, respectively, and were significant different from the manifest SE (+3.95 +/- 2.17 D) (P < 0.001). There was no statistical difference between regimen I and II in children without strabismus (P = 0.258) or aged older than 5 years (P > 0.050). CONCLUSION: In older children, regimen I was as effective as regimen II and can be used to avoid cyclopentolate toxicity.