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.

Evaluation of cycloplegic effectiveness of cyclopentolate and atropine

Background Cycloplegia is well accepted for the first refraction estimate in childhood. Yet no good evidence is offered in terms of which cyclopegia is preferable for the different ages and refractive status in children. Objective This study aimed to compare the effectiveness of cyeloplegia between 1% cyclopentolate and 1% atropine sulphate before optometry in ametropia children. Methods This was a prospective clinical trail. The self matched-pairs control randomly observation was designed. One hundred and sixty eyes of 80 children of 4-9 years old with refractive error were recruited in this study. 1% cyclopentolate eye drops were topically administered once per 5 minutes for 3 times and 1% optometry was performed 45 minutes after eye dropping. Three days after that, 1% atropine then was used 3 times per day for consecutive 3 days and again the refractive diopter was obtained. The differences of the results in autorefraetion, retinoscope and residual accommodation were compared between 1% cyclopentolate and 1% atropine eye drops. This trail was approved by the Ethic Committee and written informed consent was obtained from each custodian. Results The autorefraction values were（0.55±3.52） D and（2.22±3.52） D before and after the administration of 1% atropine with the difference value （ 1.66± 1.62） D （ t = 13.02, P = 0.00）. The autorefraction value was（1.74±3.46） D after dropping of 1% cyclopentolate and the difference value from that of 1% atropine was （0.48 ± 0.46） D （ t = 13.08, P = 0. 00）. The cyclplegic autorefractions of atropine and cyclopentolate have strong correlation （ R2 = 0.98, P = 0. 000）. The residual accommodation values were （ 0.32±0. 44 ）D and （0.05±0.41） D after dropping of 1% cyclopentolate and 1% atropine with the difference （0.27±0.55） D （ t = 4.56,P=0.00）. The difference value of refractive diopter was（0.31±0.37）D in myopic group, （0.56±0. 48）D in moderate hypermetropic group and（0.59±0.50）D in high myopic group, and that of myopic group was significantly lower than the moderate hypermetropic group （ t =- 3. 14, P = 0.00 ）. No significant difference was found in the autorefraction difference between 4-6 years group and 7-9 years group （ 0.61 ±0.53 ） D vs （ 0.49±0.39 ） D ] （ t = 1.21 ,P = 0. 23 ）. The hidden value because of accommodation had weak correlation with the difference value between atopine and cyclopentolate （ r=0.43 ,P = 0.00）. Conclusions Both 1% atropine and 1% cyclopentolate have the cycloplegic effects. This study suggestes that 1% atropine should be used for the optometry of hypermetropia children.