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。

Meta analysis of comparison between atropine and cyciopentolate in cycloplegia

Background Medical refraction after cycloplegia is the preferable choice for precise measurement of degree of refractive error. Drugs used in China for cycloplegia include atropine and tropicamlde, and the use of eyelopentolate is an alternative for ophthalmologist. However,the data for the evaluation and comparison of efficacy of the available drugs in cycloplegia is still lacking. Objective This system analysis was to evaluate the difference between atropine and cyclopentolate in cycloplegia in children. Methods A systematic literature retrieval was conducted in MEDLINE, EMbase, Google residual accommodation after cycloplegia by atropine and cyclopentolate were compared. Statistical analysis was performed using the RevMan 5. 1.0 software. Results A total of 7 studies were included in this meta analysis, including 6 cohort study design and 1 randomized, double- blinded clinical trial and 1232 eyes. For retinoscopic evaluation after cyeloplegia,no significant differences were found between eyclopentolate and atropine in children with hyperopia and myopia （ WMD = -0. 21,95% CI： -0.47-0.06, P=0. 13;WMD = -0.10,95% C1.. -0.36-0. 15,P= 0.43）. For residual accommodation after cycloplegia, no significant difference was seen between cyclopentolate and atropine in ammetropic children （WMD = 0. 30,95% CI： -0. 10-0.71, P = 0. 15 ）. Conclusions Cyclopentolate shows the same effect on the cycloplegia as atropine in children,and it can take the place of atropine in cycioplegia in childhood.