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。

The application of compound topicamide and atropine in the cycloplegic refraction for children

ObjectiveThe aim of this study was to explore the application and the correlation of atropine eye gel and compound topicamide eye drops in cycloplegic refraction for children. Methods151 cases (302 eyes) who were admitted to Eye Center of Beijing Tongren Hospital affiliated with Capital Medical University from January 2016 to March 2019 were collected. They were aged 3 to 10 years-old with an average age of (6.0±1.5) years-old, including 68 males (136 eyes) and 83 females (166 eyes). Patients were divided into hyperopia group, myopia group and mixed astigmatism group according to their refractive status. All patients underwent cycloplegic refraction using compound topicamide and atropine, resepctviely. The cycloplegic refraction results of two drugs for children in each group, including diopter of spherical power (DS), diopter of cylindrical power (DC), axial length (AL) and corrected visual acuity (CVA) were analyzed. All indices were not in accordance with the normal distribution by Kolmogorov-Smirnov normal test, which was described by median and quartile. And the rank sum test within group paired samples was performed. ResultsThere were 63 cases (126 eyes), 41 cases (82 eyes), 47 cases (94 eyes) in patients of hyperopia, mixed astigmatism group and myopia group, respectively. There was no statistical difference among three groups in gender (χ²=0.171, P>0.05), and age (F=1.399, P>0.05). In hyperopia group, DS, DC, AL and CVA of compound topicamide after cycloplegic refraction were 2.50 (1.00, 5.31) D, 1.00 (0.50, 1.75) D, 90 (85, 100) and 0.10 (0.00, 0.20); the results of atropine′s were 3.50 (2.00, 6.31) D, 1.00 (0.50, 1.75) D, 90 (85, 95), 0.10 (0.00, 0.20), respectively. According to the rank sum test of paired samples, there were statistically significant differences in DS, DC and CVA (Z=9.692, -2.726, -2.483; P<0.05); but non-significant differences in AL (Z=-0.173, P>0.05). In mixed astigmatism group, the results of compound topicamide after cycloplegic refraction were -1.00 (-2.00, -0.75) D, 3.00 (2.00, 4.00) D, 90 (85, 95), 0.10 (0.00, 0.20); the results of atropine′s were -0.50 (-1.25, 0.00) D, 3.00 (2.00, 4.00) D, 90 (85, 95), 0.10 (0.00, 0.20), respectively. According to the rank sum test of paired samples, there were statistically significant differences in DS and CVA (Z=7.778, -2.826; P<0.05); but non-significant differences in DC, AL (Z=-1.098, -0.653; P>0.05). In myopia group, the results of compound topicamide after cycloplegic refraction were -3.05 (0-6.00, -1.25) D, -1.38 (-2.50, -0.50) D, 90 (85, 95), 0.00 (0.00, 0.20); the results of atropine′s were -3.13 (-5.25, -1.00), -1.50 (-2.50, -0.50), 90.00 (85.00, 95.00), 0.10 (0.00, 0.20), respectively. According to the rank sum test of paired samples, there were statistically significant differences in DS and CVA (Z=8.388, -2.744; P<0.05); but non-significant differences in DC and AL (Z=0.511, -1.735; P>0.05). The corresponding functional relationship of 3 groups were y_atropine=1.068+ 0.976x_topicamide, y_atropine=0.775+ 0.999x_topicamide, y_atropine=0.248+ 0.949x_topicamide, respectively. In three groups, the D value of DS for patients younger than 6 years-old and aged 6 years-old or older was 1.00 (0.75, 1.44) D, 0.75 (0.50, 1.00) D, 1.00 (0.50, 1.25) D, 0.50(0.25, 0.75) D, 0.50(0.25, 0.75) D, 0.25 (0.00, 0.50) D, respectively. After the rank sum test of independent samples, there were significant difference within groups (Z=-2.261, -4.160, -2.360; P<0.05). ConclusionsAfter using two drugs in each refractive state group, there were greater difference in cycloplegic refraction for younger patients. Atropine was suggested to use for children with hyperopia and mixed astigmatism to perform the cycloplegic refraction. In special cases, mixed astigmatism and myopia children aged 6 years or younger could be modified to the topicamide mydriatic′s result by using the correlation function relationship as atropine′s. For children with myopia over 6 years-old, the compound tropine was suggested to use.