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。     

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、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。     

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。     

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.     

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。     

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。     

环戊通与阿托品儿童睫状肌麻痹效果比较的Meta分析

背景睫状肌麻痹后医学验光是目前准确测量屈光不正度数的主要方法。常用的睫状肌麻痹药物阿托品和托吡卡胺各有优缺点,环戊通（盐酸环喷托酯）是一种新的选择,但目前尚缺乏对各种药物睫状肌麻痹效果进行评价和比较的研究结果。目的系统评价环戊通与阿托品对儿童睫状肌麻痹效果的差别。方法采用严密设计的检索策略检索MEDLINE、EMbase、Google学术搜索、中国生物医学文献数据库（CBMdisc）、中国期刊全文数据库（CNKI）,对1980年1月至2011年5月公开发表的有关环戊通与阿托品睫状肌麻痹效果比较的相关文献进行Meta分析。Meta分析的最终指标为环戊通与阿托品睫状肌麻痹后的检影结果及残余调节力,用屈光度“D”表示。采用RevMan5．1．0进行统计学分析,连续性变量以加权均数差（WMD）、95％可信区间（c,）为分析统计量。结果共有7篇符合纳入标准的文献纳入研究,研究设计包括队列研究和随机双盲临床对照研究,共纳入1232眼。分析结果表明,环戊通与阿托品在远视儿童睫状肌麻痹后的检影结果差异无统计学意义（WMD=-0．21,95％CI：-0．47～0．06,P=0．13）;环戊通与阿托品应用后近视儿童的检影结果差异无统计学意义（WMD=-0．10,95％CI：-0．36～0．15,P=0．43）;二者在屈光不正儿童睫状肌麻痹后的残余调节力研究表明二者差异无统计学意义（WMD=0．30,95％C1：-0．10～0．71,P=0．15）。结论环戊通与阿托品在儿童睫状肌麻痹方面的效果相同,在儿童睫状肌麻痹验光中可相互替代使用。     

Age dependence of ocular biometric measurements under cycloplegia with tropicamide and cyclopentolate

Background : Cyclopentolate continues to be the cycloplegic of choice for refracting young children, although many studies of ocular biometry promote the use of tropicamide. Methods : To clarify the role of drug type in biometric measurements, cycloplegia was induced in two disparate age groups using cyclopentolate and tropicamide on two separate occasions. Refraction, phakometry and A-scan ultrasonography measurements were made on two groups of Tibetan children resident in Nepal. Results : Cyclopentolate produced significantly more cycloplegia in the younger group, which was supported by phakometry measurements. However, in clinical terms, the difference between the measurements was not significant. Conclusion : We conclude that although cyclopentolate is more effective than tropicamide in relaxing accommodation in young children, the use of a local anaesthetic prior to instillation of tropicamide produces refractive data virtually equivalent to that of cyclopentolate, regardless of the age group measured. However, biometric measurements may be susceptible to greater error when near fixation targets are used during phakometry procedures.     

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 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.     

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.